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Full text of "Transactions of the Medical Society of New Jersey"

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special attention is called t o the following: 



Change in Date of Annual Meeting. 

The Next Annual Meeting of the Medical 
Society of New Jersey will be held in Atlantic City 
on June 4th to 7th, 1904. 



The District Reporters of component societies are requested to 
send their reports to the Chairman of the Committee on Scientific 
Work at least 30 days before the time of the Annual Meeting. 

Reporters are reminded that their reports are published in the vol- 
ume of Transactions, and should, therefore, be carefully prepared, 
and that names and medical terms, especially, should be distinctly 
written. Reports from other physicians should be incorporated in 
their own report. As far as possible, all papers and reports should 
be typewritten. 

The Secretaries of the District Societies are requested to send with 
their list of the Officers, Annual Delegates and Active Members, in reg- 
ular standing, a separate list of the delinquent members, regular 
practitioners not members of any component society, homeopathic, 
eclectic, and all irregular practitioners of medicine, with the post 
office addresses, to the Recording Secretary, Dr. Wm. J. Chandler, 
South Orange, at least thirty days before the Annual Meetings 

The assessment upon the component societies for the year ending 
June, 1904, is $1.00 for each member. 

It will be necessary under the new Constitution and 
By-Laws for every county medical society desiring 
representation at the next annual meeting to take out a 
new charter and possibly to make changes in its by-laws. 
During the ensuing year the President and Secretary 
were especially authorized to grant charters to the socie- 
ties applying therefor. It is recommended that the 
county societies apply for their charters promptly. 



FELLOWS' PRIZE ESSAY, 



This Prize was instituted by the Fellows of the Medical 
Society of New Jersey in 1881, and is open for competi- 
tion to the members of the Component (County) Medical 
Societies. 

The Fellows have chosen as the subject of the com- 
peting Essays this year, "The Etiology of Malarial 
Diseases." The Essays must be signed with an assumed 
name and have a motto, both of which shall be endorsed 
on a sealed envelope containing the author's name, 
residence and Component Society. 

They should not contain less than 20cx> nor more than 
4000 words and must be characterized by originality in 
investigation and thought and by clearness and conciseness 
of expression, and be, in the judgment of the Committee, 
of decided value to the members of the Society and the 
profession generally. Failing in these respects no awards 
will be made. 

The Essays, with the sealed envelope, must be placed in 
the hands of the Chairman of the Committee on or be- 
fore the first day of May, 1904. The Committee will 
select the first two Essays in order of merit. To the first 
will be awarded the prize of one hundred dollars ; to the 
second, that of honorary mention. 

The unsuccessful authors will receive back their Essays 
upon their identification to the Chairman of the Com- 
mittee. The successful Essays will be the property of 
the Society and be published in its Transactions. 

E. L. B. GODFREY. M. D.. Chairman, Camden. 

DAVID C. ENGLISH. M. D., New Brunswick. 

WILLIAM ELMER. M. D.. Trenton. 

Committee. 
Camden N., J., July 25. 1903. 



TRANSACTIONS 



Medical Society 



NEW JERSEY. 



1903. 



Th€ L. J. Hardkam Printing Co., 243 6- 245 Market St., Newark, N, J. 

1903. 



8 



MEDICAL SOCIETY OF NEW JERSEY. 



♦Benj. H. Stratton 1838 

♦Jabez G. Goble 1839 

♦Thomas P. Stewart 1840 

♦Ferdinand S. SCHENCK..1841 

♦Zachariah Read 1842 

♦Abraham Skillman 1843 

♦George R. Chetwood. . . 1844 

♦Robert S. Smith 1845 

♦Charles Hannah 1846 

^Jaoob T. B. Skillman.. . . 1847 
♦Samuel H. Pennington. 1848 

♦Joseph Fithian 1849 

♦Eli AS J. Marsh 1850 

•JohnHs Phillips 1851 

♦Othn'l H. Taylor.. ..... 1852 

♦Samuel Lilly 1853 

♦A. B. Dayton 1854 

♦J. B. Coleman 1855 

^Richard M. Cooper 1856 

♦Thomas Ryerson 1857 

♦Isaac P. Coleman 1858 

♦John R. Sickler 1859 

♦Wm. Elmer i860 

♦JNO. Blane 1861 

♦JNO. WOOLVERTON ...1862 

♦Theo. R. Varick 1863 

♦Ezra M. Hunt 1864 

♦Abram Coles 1865 

♦Benjamin R. Bateman.. . 1866 

jNo. C. Johnson 1867 

♦Thomas J. Corson 1868 

♦William Pierson 1869 

♦Thomas F. Cullen 1870 



♦Charles Hasbrouck 1871 

♦Franklin Gauntt 1872 

♦T. J. Thomason 1873 

♦G. H. Larison 1874 

♦Wm. O'Gorman 1875 

♦jNO.. V. SCHENCK 1876 

♦Henry R. Baldwin 1877 

♦John S. Cook 1878 

Alex. W. Rogers 1879 

♦Alex. N. Dougherty 1880 

♦Lewis W. Oakley 1881 

♦John W. Snowden 1882 

♦Stephen Wickes 1883 

P. C. Barker 1884 

♦Joseph. Parrish 1885 

Charles J. Kipp 1886 

John W. Ward 1887 

H. Genet Taylor 1888 

♦B.A.Watson 1889 

♦Jas. S. Green 1890 

Eli AS. J. Marsh 1891 

George T. Welch 1892 

John G. Ryerson 1893 

O. H. Sproul 1894 

William Elmer 1895 

T. J. Smith 1896 

David C. English 1897 

C. R. P. Fisher 1898 

Luther M. Halsey 1899 

♦William Pierson 1900 

J. D. McGiLL 1901 

E. L. B. Godfrey 1902 



HONORARY MEMBERS. 



^David Hosack. New York 1827 

*J. W. Frai^cis :.:.. 1827 

*JOHN CONDICT, Orange. 1830 

♦Usher Parsons, Rhode Island 1839 

♦Reuben D. Murphy, Cincinnati 1839 

♦Alban G. Smith, New York 1839 

♦WiLLARD Parker. New York 1842 

♦Valentine Mott, New York 1843 

♦Jonathan Knight, New Haven 1848 

♦Nathaniel Chapman, Philadelphia 1848 

♦Alexander H. Stephens, New York 1848 

♦John C. Warren, Boston 1849 

♦Lewis C. Beck, New York 1850 

♦John C. Torrey, New York 1850 

♦George B. Wood, Philadelphia 1853 

♦H. A. BUTTOLPH, Short Hills, N. J 1854 

♦ASHBEL Woodward, Franklin, Conn.^ 1861 

♦Thomas W. Blatchford, Troy, N. Y 1886 

♦Jeremiah S. English, Manalapan, N. J 1867 

♦Stephen Wickes, Orange, N. J .1868 

♦S. O. Vanderpool, Albany. N. Y 1872 

♦Joseph Parrish, Burlington, N. J 1872 

♦Ferris Jacobs, Delhi, N. Y 1872 

C. A. LiNDSLEY, New Haven, Conn 1872 

♦Wm. Pepper. Philadelphia 1874 

S. WiER Mitchell, Philadelphia 1876 

Cyrus F. Brackett, Princeton, N. J 1880 

♦Joseph C. Hutchinson, Brooklyn, N. Y 1880 

Thomas Addis Emmett, New York 1884 

♦Isaac E. Taylor, New York 1884 

♦D. Hayes Agnew. Philadelphia 1886 

♦Jos. Leidy, Philadelphia 1886 

Frederick S. Dennis, New York 1893 



lO MEDICAL SOCIETY OF NEW JERSEY. 

♦John H. Ripley, New York 1893 

Virgil P. GiBNEY. New York 1893 

♦William Pierson, Orange, N. J 1894 

Abram Jacobi, New York 1896 

Virgil M. D. Marcy, Cape May City 1896 

♦Samuel H. Pennington, Newark, N. J 1897 

Alfred A. Woodhull, Princeton, N. J 1901 

J. Leonard Corning, New York 1902 

John Allan Wyeth, New York 1903 

William K. Van Reypen, U. S. N 1903 

Lawrence F. Flick, Philadelphia, Pa 1903 



PERMANENT DELEGATES. 



Atlantic— B. C. Pennington. Atlantic City i9«> 

W. B. Stewart, Atlantic City 1900 

E. A. Rkilly. Atlantic City >903 

W. E. Darnall. Atlantic City 1903 

J. Addison Joy. Atlantic City 1903 

Bergen— Henry C. Neer, Park Ridge 1 892 

Daniel A. Currie. Englcwood 1899 

David St. John, Hackensack i9«> 

Samuel E. Armstrong, Rutherford 1901 

Burlington— J. Howard Pugh. Burlington 1 892 

Enoch Hollingshead. Pemberton 1903 

R. H. Parsons. Mount Holly 1903 

Camden— Duncan W. Blake. Gloucester 1895 

Onan B. Gross, Camden •• 1895 

William H. Ireland, Camden 1895 

Daniel Strock, Camden 1899 

William H. Iszard, Camden 1899 

William A. Davis, Camden 19^ 

Alexander McAlister. Camden — 1903 

William S. Jones, Camden 1903 

Harry H. Sherk, Camden 1903 

Cape May— Randolph Marshall, Tuckahoe 1903 

Cumberland— S. T. Day, Port Norris 1899 

M. K. Elmer, Bridgeton 1900 

T. J. Smith, Bridgeton 1900 

O. H. Adams. Vineland 1900 

Joseph Tomlinson. Bridgeton 1902 

W. L. Newell, Millville 1903 

J. C. Applegate. Bridgeton 1902 

Essex— Charles Young, Newark 1892 

Joseph C. Young, Newark 1892 

Herman C. Bleyle. Newark 1896 

William J. Chandler, South Orange 1896 

Edward J. Ill, Newark 1896 

George R. Kent, Newark 1896 

Daniel M. Skinner, Belleville 1896 

Charles H. Bailey. Bloomfield 1898 



12 MEDICAL SOCIETY OF NEW JERSEY. 

Essex— Thomas S. Fitch, Orange 1898 

Richard C. Newton. Montclair 1 898 

William Rankin, Newark 1898 

Joshua W. Read, Newark 1898 

George A. Van VVagenen. Newark 1898 

James T. Wrightson, Newark 1898 

. Peter V. P. Hewlett, Newark 1900 

Theron Y. SUTPHEN. Newark 1900 

Charles F. Underwood, Newark 1900 

L. Eugene Hollister, Newark 1900 

Charles D. Bennett, Newark 1900 

Henry B. Whitehorne, Verona 1900 

William B. Graves, East Orange 1900 

Robert G. Stanwood, Newark 1900 

Thomas W. Harvev, Orange 1901 

Aaron K. Baldwin. Newark 1902 

John H. Bradshaw, Orange 1903 

David E. English. Millbarn 1903 

George B. Philhower, Nutley . . 1903 

Richard P. Francis, Montclair 1903 

Henry L. Coit, Newark 1903 

Theodore W. Corwin. Newark 1903 

Richard G. P. Dieffenbach, Newark 1903 

Edward Staehlin. Newark 1903 

Livingstons. Hinckley. Newark 1903 

Gloucester— George E. Reading, Woodbury 1893 

George C. Laws, Paulsboro 1895 

James Hunter, Jr., Westville 1898 

Eugene T. Oliphant, Bridgeport 1903 

Hudson— Romeo F. Chabert, Hoboken 1 892 

J. A. EXTON, Arlington . . 1898 

Jos. M. Rector, Jersey City 1900 

Frederick M. Corwin, Bayonne 1900 

Geo. E. McLaughlin, Jersey City 1900 

Mortimer Lampson, Jersey City 1900 

T. R. Chambers, Jersey City 1900 

Hunterdon— Isaac S. Cramer, Flemington 1892 

W. S. Creveling, Valley 1896 

George N. Best, Rosemont 1902 

Mercer— Cornelius Shepherd, Trenton — 1892 

R. R. Rogers, Sr., Trenton 1895 

David Warman, Trenton 1897 

Elmer Barwis, Trenton 1898 



MEDICAL SOCIETVr OF NEW JERSEY. 1 3 

Mercer— Thos. H. Mackenzie, Trenton 1900 

C. F. Adams, Trenton 1900 

J. C. Felty. Trenton 1900 

Henry B. Costill, Trenton 1902 

George H. Franklin, Hightstown 1903 

Middlesex —Edward B. Dana, Metuchen 1 898 

Ambrose Treganowan, South Amboy 1898 

F. M. Donahue. New Brunswick 1900 

J. G. Wilson, Perth Amboy 1901 

David SxEPftENS, New Brunswick 1903 

Monmouth— Henry Mitchell, Asbury Park .1892 

D. McLean Form an. Freehold 1901 

Edwin Field, Red Bank 1901 

P. B. PUxMYEA. Allentown . 1901 

George F. Wilbur, Asbury Park 1901 

F. C. Price. Imlaystown 1901 

Samuel Johnson, Asbury Park 1901 

Cyrus Knecht, Matawan 1902 

Morris— I. W. Condict, Dover 1892 

Levi Farrow. Middle Valley 1895 

Cuthbert Wigg, Boonton 1899 

James Douglass, Morristown 1901 

Stephen Pierson, Morristown. 1901 

F. W. FlaGGE, Rockaway 1901 

Calvin Anderson, Madison 1901 

Britton D. Evans. Morris Plains 1 902 

A. A. Lewis. Morristown 1903 

Passaic— W. B. Johnson, Paterson 1892 

P. A. Harris, Paterson 1893 

George H. Balleray, Paterson 1896 

John L. Leal, Paterson 1899 

C. H. Scribner, Paterson 1900 

Robt. M. Curts, Paterson 1900 

James M. Stewart, Paterson 1900 

John T. Gillson, Paterson 1900 

Matthew A. Mackintosh, Paterson 1900 

Andrew F. McBride. Paterson 1902 

Salem— B. A. Waddington, Salem 1893 

W. H. James, Pennsville 1900 

Henry Chavanne, Salem 1900 

Somerset— S. O. B. Taylor, Millstone 1897 

J. P. Hecht, Raritan 1898 

A. L. Stillwell, Somerville 1900 



14 MEDICAL SOCIETY OF NEW JERSEY. 

Somerset— Mary E. Gaston, Somerville 1902 

SussEX^-E. Morrison, Newton 1903 

B. W. Ferguson, Beemerville 1899 

H. D. Van Gaasbeck, Sussex 1903 

Union—Alonzo Pettit, Elizabeth 1893 

E. B. Silvers, Rahway 1893 

J. Ackerman Coles, Scotch Plains 1896 

T. H. Tomlinson, Plainfield 1896 

James S. Green, Elizabeth 1900 

N. L. Wilson, Elizabeth 1900 

W. U. Selover, Rahway 1900 

T. N. McLean, Elizabeth 1903 

Warren— J. M. Reese, Philipsburg 1902 

G. W. Cummins, Belvidere 1903 



Members of District Medical Societies 

REPRESENTED AT THE 

ANNUAL MEETING, 1903. 



ATLANTIC COUNTY. 

District Society organized June 7, 1880. Annual meeting first week in Febnurj,- 

Theo. Senseman. Prss., 

Car. St. Charles and Pacific. Atlaatk City 

E. H. Madden, V.-Pres,. 

Absecon 

Edward Guion. Sec. &* Treas., 

Z408 Atlantic Ave., Atlantic City 



J. J. Harward, 

X9 State Ave* Atlantic City 

E. H. Harvey. 

30 N. Florida Ave., " 



A. B. Shimer. Refi., 

606 Paafic Ave., Atlantic City 

W. M. Barnes. 

Le Grand Apartments, " 

E. C. Chew. 

385 Kentucky Ave., *« 

A. D. Cuskaden. 

aooo Atlantic Ave., " 

W. P. Conaway. 

1723 Pacific Ave,, ** 

Wm. E. Darnall. 

1704 Pacific Ave., '* 

J. F. De Silver, 

iao9 Pacific Ave., " 

T. G, Dunlap. 

931 Pacific Ave., " 

J. U. Elmer, 

Egg Harbor City 

W. B. Fayerman. 

39 N. Ohio Ave., Atlantic City 

C. E. Filbert. 

Cor. Atlantic and Nforris Aves., " 

C. M. Fish. 

Pleasantville 

M. F. Frank, 

Egg Harbor City 

J. H. Frick. 

Cor. Mass. and Madison Aves., Atlantic City 

C. Garrabrant, 

xooi Adantic Ave., Atlantic City 

G. P. Gehring. 

Bakenville 



W. M. Hodges. 
E. E. Howard, 
H. C. James, 



Somers Point 
May's Landing 

J. Addison Joy, 

X9S0 Pacific Ave., Adantic City 

D. A. Kraker, 

17x9 Pacific Ave.. ** 

Emery Marvel, 

8xx Pacific Ave., " 

Philip Marvel, 

x6i6 Pacific Ave., " 

J. C. Marshall, 

X5X7 Pacific Ave., '* 

V. W. Metzler, 

16x6 Pacific Ave., " 

H. D. Nichols. 
James North. 

39 So. Tennessee Ave., ** 

B. C. Pennington. 

X3X3 Pacific Ave., " 

W. M. Pollard. 

35 So. South Carolina Ave., " 

W. M. Powell. 

3X So. Indiana Ave., '* 

Eugene L. Reed, 

Cor. Pacific and Virginia Aves., " 

Thos. K. Reed. 

33 N. Pacific Aves., " 

Talbot Reed, 



i6 



MEDICAL SOCIETY OF NEW JERSEY. 



Edward A. Reiley, 

9o So. Tennessee Ave., Alandc City 

Walter E. Reynolds. 

97 So. Indiana Ave., ** 

E. S. Sharpe. 

34 N. Georgia Ave., " 

L. R. Souder. 

19 to Paciiic Ave., *' 

J. W. Snowball. 

1 5 19 Pacific Av:, *• 

No. members, 47. 

BERCEN 

District Society reorganized February 28, 1854, 

J. E. Pratt, Pres., Schraalenburgh 
Wm. L. Vroom. V.-Pres,, 

Rtdgewood 
Daniel A Currie. Sec'y, Englewood 
David St. John, Treas., 

Hackensack 
J. W. Proctor, Rep., Englewood 
Sam'l E. Armstrong, Rutherford 



W. B. Stewart, 

Cor. Pacific and N. C. Aves., Atlantic City 

M. L. Somers, 

2012 Pacific Ave., " 

J. B. Thompson, 

Hotel Chelsea, 

J. Bart Webster, 

13a So. Maryland Ave., " 



COUNTY. 

Annual meeting second Tnesday in April. 



M. S. Ayres, Fairview 

H. M. Banks Englewood 
J. F. Bell. 
F. C. Bradner, 

Chas. D. Brooks, Hackensack 

M. Blinckston, Westwood 

Chas. Calhoun, Rutherford 
E. E. Con over. Hasbrouck Heights 

Edgar K. Conrad, Hackensack 

J. F. Demund, Rtdgewood 
H. C. Elsing. RidgefUld Park 

Geo. Bancroft Gale. Rutherford 
No members, 38. 



T. N. Gregory. 
John J. Haring. 
C. W. Harreys. 
Fred. F. Hallett, 
Joseph Huger, 
J. B. W. Lansing, 
Howard McFadden, 
J. A. Moeing, 
H. C. Neer, 
L. B. Parsell. 
B. D. Stone, 
A. A. Swayzc, 
J. W. Terry. 
Theo. E. Townsend, 
Byron G. Van Home, 
Carrie H. Van Horn, 
J. Talmage Wyckoff, 
F. H. White, 
Max Wyler, 
Samuel J. Zabriskie, 



Englewood 

Tenafly 

Rtdgewood 

Hackensack 

Fort Lee 

Tenafly 

Hackensack 

Park Ridge 

Closter 

Westwood 

Hackensack 

Englewood 

Westwood 

, Englewood 

Englewood 

Leonia 

Hackensack 

Fort Lee 



BURLINGTON COUNTY. 

Society organized May 19, 18^9. Meets third Tuesday in January, April, June-and 
October. Annual meeting third Tuesday in April. 

John B. Cassaday, Pres,, Addison W. Taylor, Sec'y, 

Burlington Beverly 

J. Clifford Haines, V.-Pres., Enoch Hollingshead, Treas,, 

Vincentown Pemberton 



MEDICAL SOCIETY OF NEW JERSEY. 



17 



Joseph Stokes, Rep,^ Moorestown 
J. H. Pugh, Censor t Burlington 
W» C. Parry, Censor^ Hainesport 
Alex. Marcy, Jr., Censor^ River ton 
W. H. Shipps, Hist,, Bordentown 



Florence 

Columbus 

Riverton 

Mount Holly 

Burlington 



Mount Holly 
Medford 



David Baird, Jr.. 
J. E. Dubell, 
Florence A. Dyer, 
John J. Flynn, 

F. A. Gauntt. 
A. L. Gordon, 
Walter E. Hall, 
Jacob R. Haines, 
Willett P. Haines, 

G. Eugene A. Harbet, Pemberton 
I. W. Hollingshead, 

123 S, 1 8th St., Philadelphia 

CONTRIBUTING MEMBER. 

William Martin, Bristol, Pa, 

HONORARY MEMBERS. 

Charles P. Noble, i^og Locust St., Chas. H. Thomas, i^op Locust St., 

Philadelphia, Pa, Philadelphia, Pa, 

E. P. Townsend, Billings, Mont, T. T. Price, Tuckerton 
No. members, 34. 

CAMDEN COUNTY. 

Organized August 14, 1846. Annual meeting second Tuesday in May. 



J. D. Janney, Cinnaminson 

Wm. P. Melcher, Mount Holly 
C. D. Mendenhall, Bordentown 
Emma P. Weeks Metzer, 

Riverside 
R. H. Parsons. 
Elmer D. Prickett, 
Lewis L. Sharp, 
A. H. Small, 
F. S. J. Stoddart. 
N. N. Stokes, 
F. G. Stroud. 
George H. Wilkinson, 

Moorestown 
J. B. Winterstein, 
Irene D. Young, Bordentown 



Mount Holly 

Mount Holly 

Medford 

Riverside 

Reydal, Pa, 

Moorestown 



Joseph H. Wills, Pres., 

X03 Cooper, Camden 

John W. Marcy. V.-Pres,, 

Merchantville 

Paul M. Mecray, Secy, 

405 Cooper, Camden 

Joel W. Fithian, Treas,, 

608 Broadway. " 

Alfred Cramer, Hist., 

433 Penn, 

Walter S. Bray. Rep., 

3d and York, " 

Henry H. Sherk. 

a647 Westfield ave , 

Joseph S. Baer, 

565 Stevens, " 



2x5 Cooper, " 

Gloucester 



Wilson G. Bailey, 

Broadway and Pine, Camden 

Philip W. Beale. 

9th and Federal, " 

Dowling Benjamin, 
John K. Bennett, 
Duncan W. Blake, 
Charles S. Braddock, 

Haddoniieid 

Nelson M. Brinkerhoff; 

6th and Sute, Camden 

Sylvan G. Bushey. 

7th and Pine, *' 



1 8 MEDICAL SOCIETY OF NEW JERSEY. 

Robert Casperson, Ahab H. Lippencott, 

215 N. 3d, Camden ai Broadway, Camden 

William A. Davis. Alexander McAllister. 

3d and Cooper, " 582 Fedetal, *' 

Clarence B. Donges, Alexander Marcy, 

525 Broadway, " Rivertou 

John W. Donges. Frederick W. Marcy, 

535 Broadway, " 6th and Penn, Camden 

John G. Doron, J. W. Martendale, 

907 N. 6th, " 2303 Federal, 

Alfred M. Elwell. William E. Miller. 

330 Cooper. " 8th and Mt. Vernon, 

E. L. B. Godfrey, Marcus K. Mines, 

400 Linden, ♦* 53a West, 

Onan B. Gross, Joseph L. Nicholson, 

700 Market, " 400 Penn, 

Wm. J. Halbeison, M. W. Osmun, 

931 Broadway, " 815 Broadway, 

John J. Haley, Howard F. Palm, 

Gloucester 614 N. ad, 

Levi B. Hirst, William R. Powell, 

586 Federal, Camden 703 Market, 

Conrad G. Hoell. William H. Pratt, 

563 Benson, " 406 N. 6ih, 

Frank L. Horning. Sophia Presley. 

623 Market, " 323 N. 4th, 

J. Edgar Howard, Ernest S. Ramsdell. 

Haddonfield 433 Linden, 

Joseph E. Hurff, Emma M. Richardson, 

Blackwood 581 Stevens, 

William H. Ireland. Frank Neall Robinson. 

330 Cooper, Camden 518 Linden, 

William H. Iszard, Alex. S. Ross, 

41Z N. 4th, ** 565 Stevens, 

Harry Jarrett, Orris W. Saunders, 

Broadway and Cherry, ** 1813 S. 6lh, 

William B. Jennings, E. A. Y. Schellenger, 

Haddonfield 429 Cooper, 

William S. Jones, Jennie S. Sharp. 

3d and Penn, Camden 4x2 Broadway, 

Wm. W. Kain, Ezra B. Sharp, 

5th and Pine, *' 412 Broadway, 

William I. Kelchner, Charles H, Shivers, 

94a Cooper, " Haddonfield 

Grant E. Kirk, J. Anson Smith, 

1 801 Broadway, " Blackwood 

John F. Leavitt, William A. Sprengar. 

52a N. 3d, " 451 Kaighn ave., Camden 

Adrienette LeFevre, Frank O. Stem, 

Blackwood Berlin 



MEDICAL SOCIETY OF NEW JEKSEY. I9 

John R. Stevenson. William A. Wescolt. 

Haddonfidd Berlin 

Daniel Stout, Wendell P. Wingender. 

Berlin 8th and Market, Camden 

Daniel Strock, Frank M. Wood, 

ft] 8 Feileral, Camden Broadway and Washington, ** 

H. Genet Taylor. E. B. Woolston, 

305 Cooper, " Marlton 

John E. L. Vansciver. 

4th and Berkley, " 

HONORARY MEMBERS. 
G. W. Boughman. J. W. Hewlings, 

Marshalltown, New Castle Co., Del. Moorestown 

Richard C. Dean, J. Orlando White, 

U. S. Navy 339 Cooper, Camden 

Chas. G. Garrison, 

Merchantville 

No. members, 75. 

CAPE MAY COUNTY. 

Society organized March la, 1885. Meets first Tuesday in May and October. 

Jos. C. Marshall, Pres., Tuckahoe John B. Dix, 
Nathan A. Cohen, V.-Pres., Cape May Court House 

Wildwood J. S. Douglas, Tuckahoe 

Daniel K. Webster. Sec'y, Anna Hand, Cape May City 

South Seaville A. L. Leach, " •* 

Randolph Marshall. Treas., James Mecray. " " 

Tuckahoe Emelin Physic, " " 

Wm. A. Lake, Censor, J. M. Slaughter, Wildwood 

Cold spring Eugene Way, Dennisville 

V. M. D. Marcey, Censor, Julius Way, 

Cape May City Cape May Court House 

B. T. Abbott, Ocean City Wesley R. Wales, Cape May City 

George B. Adams, Wildwood 

HONORARY MEMBERS. 
Chas. M. Gandy, U, S. Army Jonathan Learning, 
J. H. Ingram, China Cape May Ccurt House 

No. members, 1 8. 

CUMBERLAND COUNTY. 

Society organized December 8, i8xB. Annual meeting second Tuesday in April. 

Ed ward S. Fogg, Pres, , Bridget on J os . Tom 1 in son , Treas. ,Bridgeion 

Mary J.Dunlap, V.-Pres., Vineland Walter P. Glendon, Rep,, 

M. K. Elmer, i^ec^y, Bridgeton Cedarville 



20 



MEDICAL SOCIETY OF NEW JERSEY. 



O. H. Adams, 
J. C. Applegate, 
Frank M. Bateman, 
Samuel Bennett, 
N. H. Burt. 
Alfred Corn well, 
T. G. Davis, 
Gafton E. Day. 
S. T. Day. 
E. L. Diament, 
H. W. Elmer. 
C. S. Frankle. 
E. Stanley Goudy, 
L. L. Hand, 
Ernest Hummell, 
Lester Hummell, 



Vineland 
Bridgeton 
Cedarville 

MillvilU 
Ocean City 
Bridgeton 

MilhnlU 

Port Nor r is 

Bridgeton 

Milhille 

Deerfield 

MillvilU 

Shiloh 

Greenwich 



Ferdinand Jones, 
A. R. Judson, 
Reba Lloyd, 
Samuel D. May hew. 
H. G. Miller, 
C. B. Neal, 
W. L. Newell. 
David H. Oliver. 
T. J. Smith, 
S. M. Snyder. 
Ellsmore Stites, 
J. R. C. Thompson, 
F. P. Wainwright, 
J. W. Wade. 
C. W. Wilson. 
S. M. Wilson. 



Millville 
New Port 
Bridgeton 

Millville 



Bridgeton 

Greenwich 
Bridgeton 



Millville 

Vineland 

Bridgeton 



ASSOCIATE MEMBERS. 



W. E. Ashton, 

20II Walnut street, Philadelphia. Pa. 

J. M. Barton, 

1 314 Spruce street. ** 

J. Chalmers DaCosta, 

2045 Walnut street, " 

B. C. Hirst. 

1821 Spruce street, " 

W. W. Keen. 

1729 Chestnut street, " 



Chas. P. Noble. 

Z509 Locust street, Philadelphia, Pa. 

Chas. A. Oliver, 

1507 Locust street. *' 

David Reisman. 

326 S. i6th street. 

H. A. Hare. 

i8oi Spruce street, " 

Judson Daland. 

317 S. i8th street, " 



HONORARY MEMBER. 
Ephriam Bateman. Cedarville 
No. members. 37. 

ESSEX COUNTY. 

Society organized June 8. 1816. Annual meeting first Tuesday in April. 

William H. Aieson, 



Walter S. Washington, Pres,, 

8 Washington place.. Newark 

Richard C. Newton. V.-Pres.^ 

Montdair 

Archibald Mercer. Sec'y, 

31 Washington street, Newark 

Charles D. Bennett. Treas., 

167 Clinton avenue, *' 

William S. Disbrow, Rep., 

151 Orchard street, ** 



Upper Montclair 

Maurice Asher, 

ao Court street, Newark 

Charles H. Bailey. 

Bloomfield 

William O. Bailey. 

282 South Orange avenue, Newark 

Aaron K. Baldwin. 

991 Plane street, *' 



MEDICAL SOCIETY OF NEW JERSEY. 21 

Samuel H. Baldwin, Henry L. Coit, 

473 Clinton avenue, Newark 51 Halaey street, Newark 

Winfred E. Baldwin, Horace C. Cory, 

469 Orange street, ** 484 Broad street, *' 

Frederick W. Becker, Everit P. Courtright, 

478 Clinton avenue, " a4 Fulton street, " 

George C. Becket, Theodore W. Corwin. 

East Orange 5 West Park street, ** 

Angelo R. Bianchi. David H. Crawford, 

103 Seventh avenue, Newark 14 Bridge street, " 

Arthur W. Bingham, Maximillian Danzis, 

East Orange 46 Meroer street, " 

William D. Bleick. Peter P. Davenport. 

340 Waverly avenue, Newark Vailsburg 

Herman C. Bleyle. William H. K. Davis. 

118 Union street, *' East Orange 

John H. Bradshaw, John Dennis, 

Orange 987 Belleville avenue, Newark 

Rudolph Braun, Winfield S. DeVausney, 

180 Polk street, Newark 55 8th avenue, ** 



William M. Brien, 


Orange Valley 


Frank Devlin, 

90 Congress street, 


«4 


James S. Brown, 


Montclair 


Richard G P. Dieflfenbach, 

212 South Orange avenue. 


it 


William Bucrman, 

35a Belmont avenue, Newark 


Daniel M. Dill, 

425 South Orange avenue. 


«( 


Charles V. Burke. 

136 Bowery i 


street, " 


Walter Dodge, 


Orange 


Edwin L. Burns, 

269 Broad 


street, " 


Arthur C. DouR:herty, 

158 Washington street, 


Newark 


Robert L. Burrage, 


East Orange 


John L. Duryee, 

436 High street, 


Newark 


Carl Btlttner. 


Orange 


Wells p. Eagleton, 

15 Lombardy street. 


(< 


Wellington Campbell, 


Short Hills 


Sarah M. Edwards. 

207 Siunmer avenue. 


If 


Fletcher F. Carman, 


Montclair 


Julius Egge, 

439 Washington street. 


« 


William E. Carroll, 

481 Broad street, Newark 


liinn Emerson, 


Orange 


Levi W. Case, 


Montclair 


David E. English, 


Millbum 



Douglas A. Cater, James R. English, 

Orange 800 Clinton avenue. Newark 

William J. Chandler, Joseph Fewsmith, 

South Orange 47 Central avenue, " 

Albion C. Christian, Thomas S. P. Fitch, 

Irvington Orange 

J. Henry Clark, Richard P. Francis, 

12 Walnut street, Newark Montclair 



22 MEDICAL SOCIETY OF NEW JERSEY 

Richard D. Freeman, 



South Orange 

Mathias T. Gaffney. 

ax I Plane street, Newark 

Ruel 8. Gage, 

Z7 Gouid avenue, " 

Frank O. Garrison, 

South Orange 

William Gauch, 

Z99 High street, Newark 

Isabel M. Geddes, 

i6 James street, " 

Robert F. Gillen, 

36 Clinton street, " 

Herman A. Glatzmaver. 

129 Wickkflfe street, " 

William *M. Goodwin, 

88 Congress street, " 

Francis S. Gordon, 

a7x Clifton avenue, " 

William B. Graves, 

East Orange 

Thomas N. Gray, 
Solomon Greenbaum, 

X43 West Kinney street, Newark 

Bernhard H. Greenfield, 

145 South Orange avenue, " 

Chauncey B. Griffiths. 

145 Monmouth street, " 

Emil A. Guenther. 

159 West Kinney street, *' 

Robert A. Guliana. 

331 Orange street, " 

John F. Hagar, 

88 Kerry street, " 

Charles W. Hagen, 

224 South Orange avenue, " 

John F. Hagerty, 

397 Central avenue, " 

Eleanor Haines. 

934 Broad street, " 

Hugh M. Hart. 

16 Gouvemeur stree*, •' 

Levi W. Halsey, 

Montclair 

Edward H. Hammill. 

233 Roseville avenue, Newark 

Thomas W. Harvey, 

Orange 



£. Zeh Hawkes, 

15 Central avenue, Newark 

Joseph H. Haydon, 

92 Brientnall place " 

John Hemstath 

36 Spruce street, " 

Herman C. H. Herold, 

77 Congress street, " 

Peter V. P. Hewlett, 

iSi Plane street, " 

William H. Hicks. 

495 South Orange avenue, " 

Livingston S. Hinckley. 

X82 Clinton avenue, " 

Edgar Holden, 

13 Central avenue, " 

Edgar Holden, Jr., 

13 Central avenue, " 

L. Eugene Hollister, 

138 Clinton avenue, " 

George J. Holmes, 

17 Pennington street, ** 

William J. Houck. 

I TO Bloomiield avenue, " 

Ralph H. Hunt, 

East Orange 

Charles L. Ill, 

1 88 Clinton avenue, Newark 

Edward J. Ill, 

Z009 Broad street, " 

Frederick C. Jacobson. 

xc8 Washington street, '* 

Jotham C. Johnson. 

II Tichenor street, " 

William A. Judson, 

270 Clifton avenue, " 

William F. Keim. 

7 Roseville avenue, " 

George R. Kent. 

37 Eighth avenue, " 

Charles J. Kipp. 

560 Broad street, " 

Joseph M. W. Kitchen, 

East Orange 

Francis E. Knowles, 

South Orange 

Louis A. Koch. 

37 Warren street. South Orange 

Henry A. Korneman. 

251 Springfield avenue, Newark 



MEDICAL SOCIETY OF NEW JERSEY. 
Stephen G. Lee. 



23 



Orange 

Charles F. Lehlbach. 

537 High street, '* 

Jesse D. Lippincott. 

304 Summer avenue, " 

Frank W. Lock wood, 

East Orange 

Herbert W. Longr. 

119 Madison street, " 

Thomas W. Loweree. 

30 Hill street, 

Calista V. Luther, 

South Orange 

Ernest M. Lyon, 

383 Broad street, Newark 

Daniel L. McCnrmick. 

952 Mulberry street, " 

Henry D. McCormick, 

Verona 

Floy McEwan, 

399 Bellevi.le avenue, Newark 

William H. McKenzie. 

94a Broad street, " 

Augusta M. Madison. 

x88 Koseville avenue, " 

James M. Maghce. 

Orange 

William H. Mariland, 

ix8a Broad street, Newark 

Henry E. Mathews. 
Sarah R. Mead, 

x6 James street, Newark 

Frank B. Meeker. 

163 First street, " 

Pancrazio M. Megaro 

313 High street, " 

Elizabeth Mercelis. 

Montclair 

Franklin L. Meyer. 

123 Halsey street, Newark 

Andrew M. Mills, 

133 Washington street, " 

Augustus J. Mitehell, 

74 South street, " 

Winthrop D. Mitchell, 

East Orange 

Clement Morris, 

77 Washington avenue, Newark 



Or«inge 



Eugene W. Murray. 

493 Summer avenue, Newark 

Frederick C. Nadier. 

33 Green street, " 

Albert B. Nash, 

10 South y 3th street, " 

Emanuel Newman. 

81 New street, '* 

Anna B. Newton, 

South Oranj^e 

Willis C. Noble, 

Montclair 

Henry W. Nolte. 

355 Mulberry street, Newark 

Victor Parsonnet. 

134 West Kinney street, " 

Edward E. Peck, 

Caldwell 

William Pennington, 

Irvington 

William Petry. 

335 South Orange avenue, Newark 

Edward D. Phelan. 

56 Pennsylvania avenue, " 

Thomas F. Phelan. 

Orange 

George P. Philhower, 

Nutley 

Frank W. Pinneo, 

159 Fourth avenue, Newark 

Charles R. Pittinger, 

82 Congress street, " 

Daniel W. Poor. 

East Orange 

Katherine Porter, 

Orange 

Palmer A. Potter, 

East Orange 

Robert C. Potter. 

34 Centre slr.et, Newark 

Henry A. Pulsford, 

South Orange 

William OG. Quinby, 

80 Columbia street, Newark 

John M. Rand, 

12 Hill street, " 

Charles H. Randall, 

50 3d avenue, *• 

William Rankin. 

23 Ced^r street, " 



24 



MEDICAL SOCIETY OF NEW JERSEY. 



Joshua W. Read. 

8a Park place, Newark 

Robert C. Ribbans, 

63 Central avenue, ** 

Edward M. Richman, 

348 Mulberry street, " 

Philip Ricord. 

968 Bank street, '' 

Samuel E. Robertson, 

344 Laiayette street, " 

Benjamin A. Robinson, 

a6s Mulberry street, ** 

Manning N. Robinson, 

159 Elm street, " 

William D. Robinson, 

East Orange 

Hugh P. Roden, 

345 Washington street, " 

William J. Roeber, 

34 Monmouth street, " 

George A. Rogers, 

394 Bank street, ** 

Robert H. Rogers, 

1195 Broad street, ' " 

Clarence Rostow. 

655 High street, *' 

George W. Rolerfort, 

343 Plane street, *' 

Mefiford Runyon, 

South Orange 

Anthony B. Russell, 

East Orange 

Charles A. Schneider. 

44 Hillside place, Newark 

William A. Schopfer, 

43 Read street, ** 

Charles A. Schureman, 

33 Hill street, 

Emanuel Schwartz. 

561 High street, " 

Edward Sealy. 

369 Washington street, " 

Edgar C. Seibert, 

Orange 

William F. Seidler, 

3 1 Ferry street, Newark 

Marco Seidman, 

489 High street, " 

Sumner Schailer. 

359 Clinton avenue, " 



Elbert S. Sherman, 

X59 Summer avenue, Newark 

William F. Shick, 

31 Park street, *' 

M. Herbert Simmons, 

Orange 

Daniel M. Skinner, 

BeUeville 

Anna L. Smith, 

Montclar 

E. Fayette Smith. 

9 Fulton street, Newark 

D. Winans Smith, 

SOI Walnut street, " 

Joseph F. Somerhof, 

146 Wilhanr street, " 

Edward Staehlin, 

493 High street, " 

Jacob S. Stage, 

95 Jefierson street, " 

Robert G. Stanwood, 

117 North 6th street, " 

Edwin Steiner, 

493 High street, " 

Carlyle E. Sutphen. 

185 Roseville avenue, ** 

Edward B. Sutphen, 

999 Broad street, " 

Thcron Y. Sutphen, 

999 Broad street, *' 

Martin J. Synnott, 

Montclair 

Henry A. Tarbell. 

Irvington 

Charles E. Teeter. 

4x8 Orange street, Newark 

Francis J. E. T^treault, 

Orange 

Charles W. Titus, 

126 North 7th street, Newark 

Henry A. Towle, 

16 Halsey street, " 

Sidney A. Twinch. 

598 Broad street, " 

Charles F. Underwood, 

359 Ml Prospect avenue, " 

Herbert B. Vail, 

Belleville 

Sarah E. Van Duyne, 

345 Belleville avenue, Newark 



MEDICAL SOCIETY OF NEW JERSEY. 



25 



George A. Van Wagenen, 




Elmer G. Wherrv. 




xoi North 6th street. 


Newark 


414 Clinton avenu% 


Newark 


Maria M. Vinton . 




Edward H. White. 






Orange 


475 Clinton avenue. 


" 


Benjamin H. Voelbel. 




William H. White. 




Vailsburg 


Bloomfield 


George N. Wait, 




Henry B. Whitehorne, 




569 High street, Newark 




Verona 


David L. Wallace. 




Miller R. Whitenack, 




303 Clinton avenue, 


<« 


19 Bathgate place, 


Newark 


Henry J. F. Wallhauser, 




Albert Wickman. 




47 New street, 


" 


335 Washington street. 




Aaron C. Ward. 




W. Stockton Wilson. 




325 Qinton avenue, 


*• 


96 Montclair avenue. 




Edwin M. Ward. 




Edward E. Worl. 




Bloomfield 


«7i High street. 




George L. Warren. 




James A. Worm ley. 




77 Houston street, 


Newark 


83 New street. 




William H. Warren. 




James T. Wrightson. 




443 Summer avenue, 




10 Central avenue. 




Frederick Webner. 




Charles Young. 




96 Clinton avenue. 




93 East Kinney street. 




Louis Weiss. 




Joseph C. Young. 




61 Beacon street. 




964 Broad street. 




George 0. Welshman. 




Charles M. Zeh. 




150 Summer avenue, 




481 Broad street. 




Lars T. Wendelboe. 








104 West street. 









No. members. 237. 



GLOUCESTER COUNTY. 

Society organized De:ember, 1818. Annual meeting, third Thursday in January. 



Joseph M. Husted, Pres., Clayton 
Wm. Brewer, V.-Pres,, 

Woodbury 
Geo. E. Reading, S^cy &* Treas., 

Woodbury 
L. M. Halsey, Censor, 

Williamsiown 
Jas. Hunter, Jr., Censor , Westville 
Harry A. Stout. Censor, Wenonah 
Wesley Grant Simmons, Rep., 

Swedesboro 
Samuel F. Ashcraft, Mullica Hill 
Henry H. Clark, Woodbury 



Henry B. Divert y. Woodbury 

Elias M. Duffield, Glassboro 
J. Gaunt Edwards, Williamsiown 

C. Frank Fisler, Clayton 

T. Franklin Gifford, Woodbury 

Chas. S. Heritage, Glassboro 

Eugene Z. Hillegas, Mantua 

George C. Laws, Paulsboro 

M. Jones Luffbary, Glassboro 
James C. McClure, Williamstown 

Eugene T. Oliphant. Bridgeport 

Cyrus B. Phillips. Hurffville 

Albert Porch, Clayton 



26 



MEDICAL SOCIETY OF NEW JERSEY. 



U. S. Grant Sparks. Mantua William M. Stratton, Woodbury 

Samuel F. Stanger, Harrisonville B. A. Waddington, Salem 

P. E. Stilwagon, Bridgeport Howard A. Wilson, Woodbury 



HONORARY MEMBERS. 

George W. Bailey, Philadelphia William H. Iszard, 



Chas. M. Burk, 
Henry C. Clark. 
Judson Daland, 
E. E. DeGrofft, 
Hobart A. Hare. Philadelphia 

No. members, 28. 



Camden 
Chas. P. Noble. Philadelphia 
Woodbury Mordecai Price, 
Philadelphia '335 Spring Orchard street, " 
iMT V ChdS. S. TurnbuU. 

Woodstawn ,935 Chestnut street, " 



HUDSON COUNTY. 

Organized October i. 185 1. Annual meeting finl Tuesday in May. 



John P. Henry, Pres., 

907 Summit avenue, Jersey City 

Imanuel Pyle, Sec'y, 

54 Monticello awnue, '* 

Henry H. BrinkerhofF, Treas., 

695 Bergen avenue, Jersey City 

Warner Allen. 

235 Ogden avenue, " 

Henry A Hers, 

109 Harrison avenue, Harrison 

Edward C. Armstrong, 

512 Fulton street, Town of Union 

Henry D. Abbott. 

24 East 33d street, Bayonne 

William J. Arliiz. 

630 Bloomfield street, Hoboken 

Edward P. Buffett, 

S04 Bergen avenue, Jersey City 

Henry H. Burnett, 

794 Washington street, Hoboken 

John J. Broderick, 

355 Pacific avenue, Jersey City 

Edward L. Brill. 

2 Madison avenue, " 

Henry J. Bogardus. 

487 Bergen avenue, " 

Oliver R. Blanchard. 

37 Clinton avenue, ** 

Nathan G. Bozeman, 

New York 



Frank F. Bowyer, 

262 Barron street, Jersey City 

John J. Bauman. 

661 Jersey avenue, *' 

J. G. Lewis Borgmeyer, 

90 W. 8th street, Bayonne 

E. Mills Baker. 

103 Wayne street, Jersey City 

Louis Baumann, 

250 5th street, ** 

W. Sims Boyd. 

22 1 8th street, " 

William M. Brooke, 

Avenue C and 42d street, Bayonne 

O. H. Ball, 

101 Garden street, Hoboken 

Burdette P. Craig. 

Boulevard and Highland ave., Jersey Gty 

John E. Corrigan, 

546 Bramhall avenue, ** 

Talbot R. Chambers, 

Mercer street and Jersey ave., '* 

Charles W. Cropper. 

85 GifTord avenue, " 

S. Herbert Culver, 

98 Magnolia avenue, " 

Romeo F. Chabert, 

X04 7th street, Hoboken 

Frederick M. Corwin, 

7 W. 6th iStreet, Bayonne 



MEDICAL SOCIETY OF NEW JERSEY. 2^ 

Charles B. Converse, N. Frederick Fcury, 

3x8 Paluade avenue, Jersey City 687 Bergen avenue, Jersey City 

John A. Chard, William Friele. 

14 Virginia avenue, '' 903 Palisade avenue, " 

John F. Connelly. Howard S. Forman, 

776 Avenue C, Bayonnc 640 Bergen avenue, " 

Frank M. Childs, George D. Fyfe, 

927 Washington street, Hoboken 70 Madison avenue, " 

D. LeRoy Culver. Charles H. Finke, 

987 York street, Jersey City 315 York street, " 

George M. Culver. P. W. Frac6, 

49 Tonndle avenue, " 106 1 ith street, Hoboken 

C. W. Crankshaw, Michael F. Foley, 

3549 Boulevard, " 710 Hudson street. " 

Gordon K. Dickinson, Archibald C. Forman, 

378 Montgomery street, '* 41 W. sad street, Bayonne 

Edwin K. Dunkel, Leonard J. Gordon, 

364 Montgomery street, " Mercer street, Jersey City 

Lucius F. Donahue, Frank D. Gray, 

33 Dodge street, Bayonne 568 Bergen avenue, '^ 

Alexander Dallas, Charles A. Gilchrist, 

34 £. asd street, " 916 Hudson street, Hoboken 

R. H. Dinglestedt, R. W. Gelbach. 

6x9 Hudson street, Hoboken 809 Hudson street, " 

Arthur DeLong, E. Gamson, 

659 Jersey avenue, Jersey City 41 W. 24th street, Bayonne 

Charles L. DeMerritt. Hugo Gill6, 

303 bhippen street, Hoboken 149 Congress street, Jersey Cuy 

Louis Dodson, Christopher D. Hill, 

663 Jersey avenue, Jersey City xoa Grand street, " 

M. O. F. Dolphin, Peter Hoffman, 

1X3 4th St., Hoboken 209 Pavonia avenue, " 

T. N. Dovey, William L. Hetherington, 

xo E. 34th street, Bayonne 999 Varick street, " 

Benjamin Edge, Edward P. Hart, 

95 Wayne street, Jersey City 316 Montgomery street, *' 

James G. Enwright, Bert. S. Heintzelmann, 

397 ^rk street, " 43 W. 33d street, Bayonne 

John R. Everitt, Samuel A. Heifer, 

38 Boyd avenue, '* 626 Hudson street, Hoboken 

Chauncey V. Everitt, Max Hecht, 

38 Boyd avenue, " 334 Shippen street. West Hoboken 

James A. Exton, J. Morgan Jones. 

75 Beach street, Arlington 121 Sip avenue, Jersey City 

Joseph F. Finn. J. Eugenia Jacques, 

X31 Danforth avenue, Jersey City 74 Waverly street, '' 

William F. Faison. Calvin F. Kyte, 

105 Grand street, " 316 Pavonia avenue, " 

John Faber, A. John Kirsten, 

389 Central avenue, " 2f9 Varick street, " 



28 



MEDICAL SOCIETY OF NEW JERSEY, 



Richard Kuehne. 

1 1 x8 Summit avenue, Jersey City 

Gustave A. Krauss. 

139 Mercer street, " 

William L. Kudlich. 

408 Hudson street, Hoboken 

Charles K. Law, 

Boulevard and Glenwood avenue, Jersey City 

Mortimer Lampson, 

322 Pacific avenue, " 

Frederick W. Lambert, 

157 Ocean avenue, '* 

Charles A. Limeburner, 

79 Danforth avenue, ** 

John T. Luck. 

Town of Union, Weehawken P. O. 

John D. McGill, 

124 Mercer street, Jersey City 

George E. McLaughlin. 

41 Crescent avenue, " 

John J. McLean, 

33 Hoboken avenue, '* 

Frank W. Mallalieu. 

62 Monticello avenue, " 

Edward Mulvaney, 

487 Jersey avenue, " 

John J. Mooney. 

556 Jersey avenue, " 

George W. Muttart, 

702 Ocean avenue, " 

Thomas J. McLoughlin, 

558 Jersey avenue, '* 

William Menger, 

421 Garden street, Hoboken 

Thomas C. McNamara. 

715 Park avenue, " 

Edward G. Marks. 

£lshermius street, Arlington 

John Nevin. 

Fairmount avenue, Jersey City 

A. Nelson, 

15 Sussex street, " 

D. I. Nalatiski. 

24 E, 22d street, Bayonne 

M. W. O'Gorman, 

38 Erie street, Jersey City 

August W. Oestman, 

961 Summit avenue, *' 

William J. Parker, 

694 Bergen avenue, " 



Charles H. Purdy, 

31a Montgomery street, Jersey City 

John C. Parsons. 

311 York street, 

Wallace Pyle, 

713 Bergen avenue, 

B. S. PoUak, 

241 Grove street, 

Luigi Pezzd, 

380 4th street, 

H. B. Don Piskorski, 

552 Jersey avenue, 

Louis Poole, 

521 Palisade avenue, West Hoboken 

Joseph M. Rector, 

307 York street, Jersey City 

Oscar J. Russi, 

256-a 9th street, " 

Murray E. Ramsey, 

9 Park street, '* 

Frederick C. Robertson. 

Madison and Clinton avenue, " 

Norman L. Rowe, 

798 Grand street, " 

Henry B. Rue, 

931 Bloomfield street, Hoboken 

James H. Rosenkranz, 

826 Hudson street, " 

George W. Shera, 

489 Jersey avenue, Jersey City 

Robert Stewart, 

Grand street, ** 

Henry Spence, 

6€x Bergen avenue, *' 

Harvey V. A. Smith, 

xoa Palisade avenue, " 

Ferdinand W. Sauer. 

314 Varick street, " 

S. Henry Sulouff, 

2 W. Hamilton place, 

Joseph F. Stack, 

2X2 Garden street, Hoboken 

Eben T. Steadman. 

635 Washington street, " 

Walter Steadman, 

Vx,^ 213 Garden street, " 

George H. Sexsmith. 

719 Avenue C, Bayonne 

Josiah L. Sanborn, 

17 El. 33d street, Bayonne 



MEDICAL SOCIETY OF NEW JERSEY. 



29 



Plincy P. Stevens, 

950 Avenue D, Bayonne 

J. S. Smith, 

x6 W, 33d street, " 

August A. Strasser. 

X15 Beach street, Arlington 

Richard Schlemm, 

xx6 Palisade avenue, Town of Union 

Frank D. Stellwagon, 

530 Union Place, " 

L. H. Sheiner, 

Bergenline avenue, " 

Manning F. Squier. 

334 Harrison avenue, Harrison 

Hamilton Vreeland, 

79 Summit avenue, Jersey City 

Clarence M. Vreeland, 

96 Danforth avenue, •• 

No. members, 148. 



W. Perry Watson, 

loz Bentley avenue. Jersey City 

John E. West. 

Cor. Ocean ave. and Union st., " 

Otto A. Wiegand. 

1x51 Summit avenue, " 

Joseph Wolf son. 

302 Montgomery street, " 

A. John Walschied, 

309 Fulton street. Town of Union 

A. W. Warden. 

Town of Union, Weehawken P. O. 

F. C. Wolff. 

Z136 Garden street, Hoboken 

James W. Ware, 

Avenue C and 46th street, Bayonne 

Stanley R. Woodruff. 

aa W. aad street, ' ' 



HUNTERDON COUNTY. 

Society organized June xa, i8az. Annual meeting fourth Tuesday in April. 



William H. Schenck, Pres., 

FUmington 
Leon T. Salmon, ist V.-Pres., 

Lamberiville 
Peter C. Young, 2d V.-Pr^s,, 

Ringoes 
O. H. Sproul, Sec*y, FUmington 
Isaac S. Cramer, Treas., " 
Geo. W. Bartow, Three Bridges 
Willard E. Berkaw, Annandale 
John L. Chamberlin, 

Sargeantsville 
Edward W. Closson, Lambertville 
Wm. S. Creveling, Stanton 



Frederick W. T>tc\itx,Frenchtown 



John H. Ewing, 
Theo. B. Fulper, 
Frank S. Grim, 
Fred. L. Johnson, 
Moses D. Knight, 
Frank W. Larison, 
Morris H. Leaver. 
Edward D. Leidy. 
Edward H. Moore, 
Alfred B. Nash, 
Geo. L. Romine, 
Howard Servis, 
Louis C. Williams, 



FUmington 

GUn Gardner 

Bafitistcwn 

Stanton 

Clinton 

Lambertville 

Quakertown 

FUmington 

White House 

Frenchtown 

Lambertville 

Junction 

Lambertville 



HONORARY MEMBERS. 

H. P. Loomis, New York City W. D. Wolverton, 

U. S, Army, Retired 

No. members, 24. 



30 



MEDICAL SOCIETY OF NEW JERSEY. 



MERCER COUNTY. 

Society organized May 73, 1848. Annual meeting second Tuesday in May. 



George R. Moore. Pr^s., Geo. H. Franklin, 

359 Hamilton avenue, Trenton 

A. Dunbar Hutchinson. V.-Pres., J. C. Felty, 

4x9 Chestnut avenue, Trenton 

Martin W. Reddan. S^cy, 

lai Perry street, " 

I. M. Shepherd. Treas., 

188 South Broad street, *' 

H. M. Anderson. Rep., 

46 West State street, *' 

D. B. Ackley, 

881 East Sute street. ** 



Hightstown 
Box 258, Trenton 



Charles F. Adams, 

5a West Sute street, ** 

Charles L. Allen, 

Box 258, 

Alex. Armstrong. 

South Broad street, " 

Elmer Barwis, 

21 X Haniihon avenue, ** 

Henry M. Beatty. 

Centre and Ferry streets, •* 

Charles P. Britton. 

State and Warren streets, *^ 

A. T. Bruere. 

X06 Spring street, *' 

John Bruy^re, 

123 Perry street, ** 

William M. Carling. 

230 South Clinton street, ** 

J. F. Chattin. 

40 West State street. Trenton 

W. A. Clark, 

51 West State street, *' 

J. C. Craythorn. 

Spring and Calhoun streets, *' 

Paul L. Cort, 

Box 258, " 

Henry B. Costell, 

State and Clinton streets, " 

Frank V. Cantwell. 

Broad Street Bank Building, ** 

A. H. Dey, 

430 East State street, '* 

Wm. Elmer, 

44 West State street, '' 

E. K. Fee, 

Lawrenceville 



Samuel Freeman. 

South Broad street, '' 

E. J. Gordon, 

xoio South Clinton avenue, ^* 

W. J. Hall. 

231 North Wairen street, ** 

Chas. H. Halcombe, 

334 We»t State street, " 

E. S. Hawke. 

22 Montgomery street, ^\ 

J. F. Higgins, 

398 South Warren street, ** 

A. I. Hunt, 

Ha'nilton square, ^* 

Mozart Jenkins. 

136 Walnut avenue, Trenton 

M. M. Kent. 

South Warren street, Trenton 

Wm. S. Lalor. 

129 North Warren street, " 

Lyman Leaviit. 

219 Chestnut avenue, *^ 

Thos. H. MacKenzie. 

538 East St;it«: street, 

Walter Madden. 

219 Centre street. ** 

Benj. W. McGalliard. 

229 East Sute street, ** 

James McGuire. 

South Broad street. ** 

Chas. H. Mcllwaine. 

40 West Stale street, ** 

Chas. Mitchell. 

Centre street, ** 

H. G. Norton. 

429 East State street, *' 

N. B. Oliphant. 

152 West State street. " 

Geo. H. Parker. 

420 East State street, ^^ 

Elmer H. Rogers. • 

1 26 North Warren street, Trenton 

R. R. Rogers, Sr.. 

xxo East Hanover street, *' 



MEDICAL SOCIETY OF NEW JERSEY. 



3» 



R. R. Rogers, Jr.. 

6io Perrj' street, Trenton 


W. B. Van Duyn. 

Perry street, Trenton 


Geo. M. Ridgway. 

39 West State street, " 


Jno. W. Ward. 

Box 958, " 


F. G. Scammell, 

413 East State street, '' 


David Warman, 

Chestnut avenue, '* 


Jos. B. Shaw, 

1 19 South Warren street, " 


Chas. H. Waters. 

4 Pennington avenue, " 


Cornelius Shepherd. 

186 Soulh Broad street, ** 


David F. Weeks, 

400 West Stote sireet, " 


Geo. N. J. Sommer, 

299 Perry street, Trenton 


J. H. Wikoff, 

Princeton 


W. D. Stevenson, 

303 East State street, " 


Wm. Wilbur. 

Hightstown 


G. Schoening, 

223 Perry street, *' 


P. W. Yard. 

^^^ South Broad street, Trenton 


Geo. E. Titus, 

Hightstown 





HONORARY MEMBER. 
Dr. Joseph K. Young, 

999 South Sixteenth htrect, Philadelphia, Pa. 



No. members. 65. 



MIDDLESEX COUNTY. 

Society organized June i6, 1816. Annual meeting third Wednesday in ApriL 



William E. Ramsey, Pres.. 

193 High street, Perth Amboy 

Frank M Donohue, V.-Pres , 

139 Albany street, New Brunswick 

William M Moore. Sec'y, 

75 Livingston avenue, ** 

David C. English. Treas,, 

363 George street, " 

Arthur L. Smith, Rep., 

55 Livingston avenue, " 

John C. Albright. 

194 Broadway, South Amboy 

Thomas Alsop, 

George and Washington sts.. New Brunswick 

John J. Bissett. 

Main street. South River 

H. Martyn Brace, 

179 High street, Perth Amboy 

Edgar Carroll, 

Main street, Dayton 

S. V. D. Clark, 

89 Bayard street. New Brunswick 

A. Schuyler Clark, 

George and Washington sts., " 



Edward B. Dana. 

Main street, Metuchen 

Benj. Guttman. 

I Elm Row, New Brunswick 

Edward E. Haines. 

134 David street. South Amboy 

Frank C. Henry. 

134 Sute street, Perth Amboy 

George J. Howell,' 

294 Madison avenue, " 

A. Clark Hunt, 

Holly street, Metuchen 

Henry H. Jane way, 

XX Livingston avenue. New Brunswick 

Henry Levy, 

102 Smith street, Perth Abmoy 

John L. Lund, 

x8i High street, " 

E. A. Meacham, 

South Amboy 

William Vl McKenzie, 

Graham avenue, Metuchen 

Daniel L. Morrison, 

55 Paterson street. New Brunswick 



32 MEDICAL SOCIETY OF NEW JERSEY. 

Henry C. Symmes, 



Ferdinand E. Riva, 

Main and Riva avenues, Milltown 

Clarence M. Slack, 

50 Livingston avenue. New Brunswick 

David Stephens, 

999 George street, " 

Ira T. spencer, 

Main street, Woodbridge 

John L. Suydam, 

Jamesburg 



Cranbury 



Ambrose Treganowan, 

Main street, South Amboy 

George W. Tyrrell, 

332 State street, Perth Amboy 

J. Leon White, 

Main street. South Amboy 

John G. Wilson, 

186 High street, Perth Amboy 



Henry G. Cooke, 

7 Livingston avenue, New Brunswick 

No. members, 34. 



HONORARY MEMBERS. 

John C. Holmes, 



Cranbury 



MONMOUTH COUNTY. 

Society organized June i6, 1816. Annual meeting third Monday in May. 



Wm. MacMillan, Pres., 

, Perrineville 

D. McLean For man, Sec'y, 

Freehold 
I. S. Long, Treas., " 

Scudder J. Wooley. Rep., 

Long Branch 
A. T. Applegate, Englishtown 
George H. Baker, Long Branch 

E. M. Beach, West Long Branch 
R. S. Bennett, Asbury Park 
A.G.Brown, Red Bank 
Wm. W. Beveridge, Asbury Park 
Harvey Brown, Freehold 
Henry G. Cook, New Brunswick 
Ellis W. Crater, Ocean Port 
J. F . Davison, Asbury Park 
V. M. Disbrow, Lakewood 
Edwin Field, Red Bank 
D. D. Hendrickson, Middleiown 
H. A. Hendrickson, 

Atlantic Highlands 
Wm. M. Hepburn, Freehold 

A. H. Higgins, Manasquan 



G. C. Hoagland, Keypott 

W. H. Ingling, Adelphia 

A. J. Jackson, * Matawan 

Samuel Johnson, Asbury Park 

W. R. Kin mouth, Farmingdale 

Cyrus Knecht, Matawan 

S. R. Knight, Spring Lake 

W. U. Kurtz. Eatontown 
Sarah F. Mcintosh, Asbury Park 

Henry Mitchell. Asbury Park 

F. C. Price, Imlaystown 

P. B. Pumyea, Allentown 

James Read, Sea Bright 

Edgar Roberts, Keyport 

P. J. Rafferty, Red Bank 

Harry E. Shaw, Long Branch 

W. G. Schaufler, Lakewood 

Edw. F. Taylor, Middletown 

John Taylor, Asbury Park 
Chas. H. Thompson, Belmar 
C. R. Treat, 

W. W. Trout, Spring Lake 

Wm. B. Warner, Red Bank 

George F. Wilbur, Asbury Park 



MEDICAL SOCIETY OF NEW JERSEY. 



33 



Alex. Williamson, 
W. S. Whitmore. 



Asbury Park I, B. Wainwright, Matiasquan 
Oceanic 
HONORARY MEMBER. 
George T. Welsh, Passaic 
No. members, 47. 

MORRIS COUNTY. 

Society organized June z, i3t5. Annual meeting second Tuesday in ^Xarch. 

J. Willard Farrow. Pres., Dover Francis H. Glazebrook, 
H. M. O'Riley, VicePres., 

Morristawn 
H. W. Kice. Secy, . Wharton 
Jas. Douglas, Treas., Morrisiown 
Stephen Pierson, Rep., " 



Morrisiown 
Elliott Gorton, Summit 

J. B. Griswold, Morrisiown 

H. A. Henriques, " 

Fred. C. Horsford, Morris Plains 



N. H. Adsit, 


Succasunna 


Geo. L. Johnson, 


" 


C. Anderson, 


Madison 


A. A. Lewis, 


" 


R. D. Baker. 


Morris Plains 


H. B. McCarroll. 


fi 


G. A. Becker, 


Morrisiown 


A. A. Macwithey, 


Pompton 


C. C. Beling, 


Morris Plains 


P. S. Mallon, 


Morris Plains 


L. F. Bishop, 


Morrisiown 


W. H. Martin. 


Madison 


A. E. Carpenter, 


Boonion 


C. N. Miller, 


German Valley 


A. R. Corwin, 


Morris Plains 


L. L. Mial, 


Morrisiown 


E. P. Cooper, 


Troy Hills 


Clifford Mills, 


•• 


Harry A. Cossit, 


Morris Plains 


F. W. Owens, 


i< 


T. R. Crittenden, 


Dover 


S. H. Reed, 


Madison 


A. W. Condict, 


" 


Wm. H. Risk, 


Summit 


I. W. Condict, 


•• 


J. B. Risk, 


*• 


R. L. Cook, 


" 


J. G Ryerson, 


Boonion 


G. 0. Cummins, 


<« 


M. S. Simpson, 


Middle Valley 


Harris Day, 


Chester 


E. Sutton, 


German Valley 


H. V. Day, 


Bloomingdale 


J. L. Taylor, 


Boonion 


G. S. DeGroot, 


Mendham 


H. C. Upchurch, 


Kenvil 


B. D. Evans, 


Morris Plains 


Harry Vaughn, 


Morrisiown 


Levi Farrow, 


Hackettstown 


Geo. W. V. Wilkinson, 


F. W. Flagge. 


Rockaway 


J. Walters, 


Wharton 


G. H. Foster, 


" 


H. S. Wheeler 


Whippany 


W. S. Foster, 


Flanders 


Cuthbert Wigg, 


Boonion 


Wm. M. Garrison, 


Morris Plains 


W. J. Wolfe. 


Chaihatn 




HONORARY MEMBERS. 




P. C. Barker, 


Morrisiown 


P. A. Harris. 


Paierson 


No, members, 5 


8. 







34 



MEDICAL SOCIETY OF NEW JERSEY. 



PASSAIC COUNTY. 

Society organized July 14, 1844. Annual meeting third Tue^ay in April. 



M. W. Gillson. Pres.. 

1 1 Lee Place, Paterson 

J. W. Smith. V.-Pres.. 

33 Clark street. *' 

H. V. Pike. 5^.->. 

144 Hamilton avenue, *' 

D. T. B9wden. Treas . 

X 17 Paterson street. " 

A. F. Alexander. A'ep.. 

379 Union avenue. ** 

J. M. Stewart, Censor, 

Van Houton street. *' 

John L. Leal. Censor, 

39 Hamilton street. ** 

Henry Kip, Censor, 

90 Fair street, ** 

F.[E. Agnew, 

29 Hamilton street, ** 

J. W. Atkinson. 

27 Church stteet, *' 

George H. Balleray. 

1x5 Broadway, *' 

J. H. Banta, 

1 19 Broadway, " 

J. V. Bergin, 

Bridge street, ** 

Charles R. Blundell. 
W. Blundell. 

236 Main street, *' 

J. A. Browne. 

310 Grand street, " 

V. E. Bullen, 

156 Broadway, ** 

C. M. Campbell, 

642 Main street, '* 

W. H. Carroll. 

II Jefferson street, Passaic 

D. R. Crounse. 

84 Bloomfield avenue, ** 

R. M. Curts, 

30 Church street, Paterson 

Jas. H. Curts, 

30 Church street, " 

G. S. Davenport, 



S. De Jager. 



Garfield 



83 Bridge street, Paterson 



F. Y, C. Demarest. 

39 Academy street, Passaic 

Edward F. Denner, 

26 Church street, Paterson 

F. B. Donahue, 

387 Main street, *' 

George Fisher, 

77 Fair street. ** 

T. J. Fitzmaurice, 

130 Beech street, *' 

William Flitcroft. 

510 River street, ** 

O. V. Garnett. 

154 Straight street, " 

J. T. Gillson, 

391 Main street. '* 

Philander A. Harris. 

26 Church street ** 

J. H. Henggeler, 

Bridge street. '* 

E. L. Henion, 

16 Church street. ** 

W. B. Johnson, 

170 Broadw^ay, " 

C. J. Kane, 

349 Grand street, " 

T. J. Kane. 

349 Grand street, '^ 

F. J. Keller, 

349 Totowa avenue, '' 

H. H. Lucas. 

192 Van Houten street, " 

Bryan C. Magennis. 

Bridge street, ** 

M. A. Mackintosh, 

267 Ellison street, '^ 

E. J. Marsh, 

600 Park avenue, '* 

E. J. Marsh, Jr.. 

Van Houten street, ** 

W. W. McAlister, 

Little Falls 

A. F. McBride. 

397 Main street. Paterson 

John C. McCoy. 

158 Broadway, " 

Frank McDede, 

908 Main street, " 



MEDICAL SOCIETY OF NEW JERSEY. 
VV. R. Smith, 
R. Stinson, 



35 



J. R. Merrill. 

94 Church street, Patereon 

Daniel T. Millspaugh, 

43 Totowa avenue, '* 

E. B. Morgan, 



Little Falls 



C. F. W. Meyers. 

108 Broadway, ** 

R. Neer, 

85 Hamilton avenue, ^* 

W. Neer, 

87 Fair street, " 

W. K. Newton. 

379 EUlison street, ** 

T. F. OGrady, 

374 Grand street, ** 

J. O'Donnell, 

387 Main street, ^* 

H. Parke. 

273 Main street, ^* 

J. P. Paxton, 

A. W. Rogers. 

385 Broadway, " 

B. H. Rogers, 

213 Broadway, ** 

John N. Ryan. 

275 Passaic street, Passaic 

F. R. Sandt. 

354 Park avenue, Patcr«on 

C. H. Scribner. 

79 Ward street, " 



Passaic 



z S2 Broadway, Paterson 

Isaac Surnamer, 

53 Bridge street, ** 

M, J. Synott. 

Montclair 

J. Tattersall, 

1042 Main street. Paterson 

G. W. Terriberry, 

146 Broadway, ** 

R. A. Terhune, 
P. H. Terhunel 

126 Park place, ** 

F. H. Todd. 

X20 Broadway, Paterson 

G. E. Tuers, 

x6 Church street, ** 

A. B. Vanderbeck. 

160 Broadway, ** 

A. Ward Van Riper. 

907 Main avenue, Passaic 

C. Van Riper, 

207 Main avenue, ** 

George Vreeland, 

127 Hamburg avenue, Paterson 



F. Vigna, 



35 Ward street. 



No. members, 79. 

SALEM COUNTY. 

Society organized May 4, 1880. Annual meeting first Wednesday in May. 



H.T.Johnson. Pr^s., Pedricktown 
John F. Smith, V.-Pres., Salem 
Henry Chavanne, Secy &* Treas., 
Salem 
W. H. Carpenter, Rep. 
Dan'l Garrison. Censor, 

Pennsgrcrve 
N. S. Hires, Censor, Salem 



W. H. James, Censor, Pennsville 

F. Bilderback. Salem 
R. M. Davis, Salem 
E. E. DeGroft, Woodstown 
W. L. Ewen, Allcnvay 

G. W. H. Fitch, Dareto7vn 
W. T. Good, Quint on 
L. M. Halsey, Williamsta'vn 



36 



MEDICAL SOCIETY OF NEW JERSEY. 



Geo. E. Reading, 
J. W. Richards, 



Woodbury C. M. Sherron, 
For/ Mott B. A. Waddington. 

ASSOCIATE MEMBER. 
W. A. Jaquett, D. D. S., Salem, 



Salem 



No. members, i8. 



SOMERSET COUNTY. 

Society organized May, z8i6. Annual meeting last Tuesday in April. 



C.R.P.Fisher. Pres., Bound Brook 
J. P. Hecht, V. Pres., Somerville 
J. H, Buchanan, Secy, 

North Plainfiild 
T. ^. Flynn, Treas., Somerville 
W. H. Long. Jr., Rep., 
J. B. Beekman, Pluckemin 

J. H. Cooper, Middlebush 

H. V. Davis, North Branch 

A. H. Dundon. North Plainfield 
E. B. Funkhauser, Skillman 

Mary E. Gaston, Somennlle 

George Henry, Raritan 



F. J. Hughes. North Plainfield 
B. B. Matthews, Bound Brook 
J. F. McWilliams. 
Josiah Meigh. 



W. H. Merrell, 
M. C. Smalley, 
A. L. Stillwell. 
W. J. Swinton, 
S. O. B. Taylor, 
J. D. Ten Eyck, 
F. A. Wild, 
H. M. Weeks. 
P. J. Zeglio, 



Somerville 
Bernardsville 
South Branch 
Gladstone 

Somerville 

Millstone 

Franklin Park 

Bound Brook 

Skillman 

North Plainfield 



HONORARY MEMBER. 
John W, Ward, Trenton. 

ASSOCIATE MEMBER. 
E. R. Voorhees. M. D. C, Somerville. 

No. members, 25. 

SUSSEX: COUNTY. 

Society organized August 22, 1829. Annual meeting third Tuesday in May. 



Milton N. Armstrong. Pres., 

Newton 

Harvey J. McClougham, V.-Pres., 
Neivton 

Shepard Voorhees, Secy, 

E. Morrison, Treas., 

T. H. Andress, Sparta 

L. G. Burd, Ogdensburg 



Martin Cole, 
Jos. G. Coleman, 
C. "K. Davison, 
C. E. Dowling, 
Chas. M. Dunning, 
B. W. Ferguson, 
Bruno Hood, 
M. D. Hughes, 



Hainesville 

Hamburg 

Stanhope 

Sparta 

Franklin 

Beemerville 

Neivton 

Layton 



MEDICAL SOCIETY OF NEW JERSEY. 



37 



P. N. Jacobus. Newton J. B. Pellet. Hamburg 

J. N. Miller. " J. C. Price, Branchville 

John Moore, Sussex H. D. Van Gaasbeck, Sussex 

HONORARY MEMBERS. 
Joseph Hedges, Branchville 
No. members. 20. 

UNION COUNTY. 

Society organized June 7, 1869. Annual meeting second Wednesday in April. 



Arthur Stern. Pres., 


J. T. Fritls. 


Plainfield 


Henry C. Pierson, V. Pres,, 

Rcselle 


Joseph Funk. 

6(5 Elizabeth avenue, Elizabeth 


John P. Reilley, Secy, 

ai5 Elizabeth avenue, Elizabeth 


Edgar B. Grier, 

1 145 East Jersey street, ** 


Robert R. Monifort. Ireas,, 

105X East Jersey street, ** 


James S Green, 

463 North Broad street. 


P. DuBois Bunting. Rep,, 

11 Third street. " 


G. E. Galloway, 


Rahway 


F. C. Ard. 


Plainfield 


William Gale. 


Westfield 


Frederick R. Bailey. 

1165 East Jersey 




W. F. Gaston, 


Plainfield 


Thomas F. Burnett. 

249 Court 


street, " 


H. Page Hough, 


Rahway 


William C. Boone. 


Plainfield 


J. B. Harrison, 


WestfieU 


W. E. Cladek, 


Rahway 


B. W. Hoagland, 


Woodbndge 


J. Ackerman Coles, 


Scotch Plains 


Ellis W. Hedges, 


Plainfield 


J. H. P. Connover. 

1x43 East Jersey 


street. Elizabeth 


B. Van 0. Hedges, 


«* 


F. M, Corwin. 


Bergen Point 


Cari R. Kepler, 

94 Central Park West, New York City 


John H. Carman. 


Plainfield 


F. A. Kinch. 


Westfidd 


Marc. L. Clowson, 


.. 


Samuel Koengut, 

116 Bond street, Elizabeth 


N. W.Currie, 




Horace R. Livengood. 





Alfred J. Donavan, 

13a Fast Jersey street, Elizabeth 

Thomas E. Dolan, 

129 Livingston street, ** 

James R. English, Jr., 

Irvington 

George W. Endicott, 

Plainfield 



Thomas F. Livengood, 

1 105 East Jersey street, ** 

Monroe D. Long. 

Plainfield 

Victor Mravlag, 

1063 East Jersey street, Elizabeth 

Thomas N. McLean. 

1 1 44 East Hroad street. *^ 



38 MEDICAL SOCIETY OF NEW JERSEY. 

George W. McCallion. W. Updyke Selover, 

70a First avenue, Elizabeth Rah way 



J. K. McConnell. 


Cnmford 


Elihu B. Silvers. 


William H. Murray. 


Plamfield 


Frederick W. Sell, 


Edward R. O'Reilly, 

167 Second street, 




Milton A. Shangle. 

1148 East Jersry street. Elizabeth 


Albert Peltis, 


Plainfield 


R. R. Sinclair, 

Westfield 


James T. Perkins, 


Cranfoid 


G. W. Strickland. 

Roselle 


Alonzo Pettit. 

X 16 West Grand stieet, 


Elizabeth 


William F. Turner. 

• XQ46 Elizabeth avenue. Elizabeth 


Frederick H. Pierson, 

440 N. Broad street. 


u 


T. H. Tomlinson, 

Plainfield 


J. B. Probasco, 


Plainfield 


R. D. Tomlinson. 


Norman H. Probasco, 


»i 


N. W. Voorhees. 

097 Notth Broad street, Elizabeth 


Stephen T. Quinn. 

z«5 Jefferson avenue. 


Elizabeth 


A. F. Van Horn. 

Plainfield 


John M. Randolph. 


Rah way 


Norton L. Wilson. 

332 North Broad street, Elizabeth 


J. J. Reason, 


Carteret 


Rufus B. Whitehead. 

36 ITiird street, " 


Charles H. Schlichter. 

X053 Elizabeth avenue. 


Elizabeth 


F. W. Wescott. 

Fan wood 


Russell A. Shirrefs. 

X158 lilast Jersey street, 


« 




No. members, 69. 







WARREN COUNTY. 

Society organized February 15, 1826. Annual meeting first Tuesday in June. 

Chas. M. Williams, Pres., Frank W. Curtis, Stewartsville 

Washington F. W. Haggerty. Vienna 

Wm. C. Allen, K. Pres., L. B. Hoagland. Oxford 

Blair stown John C. Johnson, Blair stown 

Wm. J. Burd. Secy, Belvidere F. J. LaRiew. Asbury 

Wm. H. McGee. Treas., •' L. C. Osmun, Washington. D. C, 

J. H. Griffith, Rep., PhilUpsburg Louis C. Osmun, Hackettstown 

W. C. Albertson. Belvidere J. M. Reese, PhilUpsburg 

Isaac Barber, PhilUpsburg C. B. Smith, Washington 

C. H. Boyer. Riegelsville G. O. Tunison. Oxford 

H. O. Carhart, Blairstown Alva C. Van Syckle. Hackettstown 

G. W. Cummins. Belvidere 

No. members, 21. 



SUMMARY. 



Atlantic, 
Bergen, 
Burlington, 
Camden, 
Cape May, 
Cumberland, 
Essex, - 
Gloucester, - 
Hudson, 
Hunterdon, - 



47 Mercer, - 

38 Middlesex, 

34 Monmouth, 

75 Morris, 

18 Passaic, • 

37 Salem, 

237 Somerset, 

28 Sussex, 

148 Union, - 

24 Warren, 



65 
34 
47 
58 
79 
18 

25 
20 

69 

21 



TRANSACTIONS 

OF THE 

Medical Society of New Jersey. 



One Hundred and Thirty-Seventh Annual Meeting. 



held in asbury park, n. j.. 

June 23, 24 and 25, 1903. 

S. L. B. GODFREY, M. D.. of Camden, President. 



FIRST DAY— TUESDAY, JUNE 23D. 

The meeting was called to order at the Coleiman 
House, Asbury Park, by the President, Dr. E. L. B. God- 
frey, of Camden, at 1 1.30 A. M. 

The report of the Committee on Credentials was pre- 
sented by Dr. VV. J. Chandler as follows: 

Twenty-six delegates from fourteen District Societies have thus far 
produced their credentials and are entitled to vote at this session. 

The following reporters have fulfilled the requirements of the By- 
Laws and are entitled to the privileges of ex-officio delegates : 

Atlantic— K. B. Shimer. 
Bergen—], W. Proctor. 
Burlington— ]ostp\i Stokes. 
Camden— ]ostig!h. H. Wills. 
Cape May — Daniel K. Webster. 
Cumderland—V/ai\ier P. Glendon. 
Essex — William S. Disbrow. 
Hunterdon — Leon T. Salmon. 
Gloucester — Wesley Grant Simmons. 
Mercer — Martin W. Reddan. 
Middlesex - knhnr L. Smith. 



42 MEDICAL SOCIETY OF NEW JERSEY. 

Morris — Stephen Sutphen. 

SaUtn—V^, H. Carpenter. 

Somerset—^ . H. Long, Jr. 

5«w/jr — Sheppard Vorhees. 

IVarren-], H.Griffith. 

Nominees for permanent delegates' are presented by fourteen 
District Societies as follows. Atlantic, Burlington, Camden, Cape 
May, Cumberland, Essex, Gloucester, Middlesex, Morris, Passaic, 
Salem, Sussex, Union and Warren. 

The following nominees have presented certificates in proper fcg*m 
and are eligible for election : 

Atlantic County— IL, A. Reilly, Atlantic City; W. E. Darnall. 
Atlantic City ; J. A. Joy. Atlantic City (to fill vacancy). 

Camden County — Alexander McAlister, Camden (to fill vacancy). 

Cape May County — Randolph Marshall, Tuckahoe. 

Cumberland County -Vf, L. Newell, Millville; J. C Applegate, 
Bridgeton. 

Essex County --Htrwy L. Coit, Newark; Theodore W. Corwin, 
Newark ; John H. Bradshaw, Orange ; David E. English, Millburn ; 
Richard G. P. Dieffenbach, Newark ; G. P. Philhower, Nutley ; Ed- 
ward Staehlin, Newark ; Livingston S. Hinckley, Newark ; Richard 
P. Francis, Montclair. 

Gloucester County — Eugene T. Oliphant, Bridgeport. 

Morris County— A, A. Lewis, Morristown. 

Sussex County— H, D. Van Gaasbeck, Sussex (to fill vacancy) ; E. 
Morrison, Newton. 

Union County— T, N. McLean, Elizabeth. 
Warren County— G, W. Cummins, Belvidere. 

Bergen, Hudson, Hunterdon, Monmouth and Somerset make no 
nominations. 

Mercer makes no report. 

The following nominees have failed to present their credentials : 

Camden County — Joseph E. Hurff, Blackwood ; William S. Jones, 
Camden ; Harry H. Sherk, Camden. 

Middlesex County — David Stephens, New Brunswick. 

Passaic County — William K. Newton. Paterson. 

Salem County—^. E. DeGroft, Woodstown (to fill vacancy) ; 
Daniel Garrison, Pennsgrove. 

Imperfect credentials were presented by E. Hollingshead, of Pern- 



MINUTES. 43 

bcrton, and R. H. Parsons, of Mount Holly, and they have been 
returned for correction. If proper certificates are produced they can 
be presented to you at a later period in the session. 

On motion, the report was accepted. 

The following members, as shown by the Registration 
Book, were present : 

FELLOWS. 
Jno. C. Johnson. Alex. W. Rogers, P. C. Barker, Charles J. Kipp, 
John W. Ward. H. Genet Taylor, Elias J. Marsh, John G. Rycrson. 
O. H. Sproul, William Elmer. T. J. Smith. David C. English, C. R. 
P. Fisher. Luther M. Halsey, J. D. McGill. 

OFFICERS. 

President^ E. L. B. Godfrey, Camden ; Vice-Presidents^ Henry 
Mitchell, Asbury Park; A. W. Taylor, Beverly ; Walter B. Johnson, 
Paterson ; Corresponding Secretary^ E. W. Hedges, Plain field ; 
Recording Secretary^ William J. Chandler, South Orange; Treas- 
urer, Archibald Mercer. Newark; Standing Committee, Henry W. 
Elmer, Chairman, Bridgeton ; B. A. Waddington, Salem ; W. H. 
Ireland, Camden; Charles Young, Newark; John P. Hecht, Somer- 
ville. 

PERMANENT DELEGATES. 

Atlantic -B. C. Pennington, Atlantic City; W. B. Stewart, 
Atlantic City ; Wm. E. Darnall. Atlantic City. 

Bergen— Henry C. Neer, Park Ridge ; David St. John, Hacken- 
sack ; Samuel E. Armstrong, Rutherford. 

Burlington— J. Howard Pugh, Burlington ; E. HoUingshead, 
Pemberton ; R. H. Parsons, Mount Holly. 

Camden— Duncan W. Blake. Gloucester; William H. Ireland, 
Camden ; Daniel Strock, Camden ; William A. Davis, Camden ; Harry 
H. Sherk. Camden ; Alexander McAlister, Camden ; Wm. S. Jones, 
Camden. 

Cumberland— S. T. Day, Port Norris ; J. A. Applegate. Bridge- 
ton ; M. K. Elmer, Bridgeton ; Joseph Tomlinson, Bridgeton. 

Essex — Charles Young, Newark ; Joseph C. Young, Newark ; 
Herman C. Bleyle, Newark ; William J. Chandler, South Orange ; 
Edward J. Ill, Newark ; George R. Kent, Newark ; Daniel M. Skin- 
ner, Belleville ; Charles H. Bailey, Bloomfield ; Thomas S. P. Fitch, 



44 MEDICAL SOCIETY OF NEW JERSEY. 

Orange ; Richard C. Newton, Montclair ; Joshua W. Read, Newark ; 
Jannes T. Wrightson. Newark ; Peter V. P. Hewlett, Newark ; Theron 
Y. Sutphen, Newark ; Charles F. Underwood, Newark ; L. Engene 
Hollister, Newark ; Charles D. Bennett, Newark ; William B.Graves, 
East Orange; Robert G. Stanwood, Newark; Thomas W.Harvey. 
Orange; Aaron K. Baldwin, Newark; Edward Staehhn, Newark; 
Theo. W. Corwin, Newark; L. S. Hinckley, Newark; R. G. P. 
Dieffenbach, Newark; G. B. Philhower. Nulley ; D. E. English, 
Millbum. 

Gloucester— George E. Reading, Woodbury ; James Hunter, Jr.. 
Westville ; E. T. Oliphant, Bridgeport. 

Hudson- J. D. McGill, Jersey City ; Romeo F. Chabert, Hoboken ; 
Jos. M. Rector. Jersey City ; Frederick N. Corwin, Bayonne ; George 
E. McLaughlin, Jersey City ; Mortimer Lampson, Jersey City ; T. R. 
Chambers, Jersey City. 

Hunterdon— Isaac S. Cramer, Flemiogton ; W. S. Creveling, 

Valley. 

Mercer— Cornelius Shepherd, Trenton ; Richard R. Rogers, Sr., 
Trenton ; David Warman, Trenton ; J. C. Felty Trenton ; G. H. 
Franklin, Hightstown. 

Middlesex— Edward B. Dana. Jr., Metuchen ; Ambrose Trcga- 
anowan. South Am boy ; F, M. Donahue, New Brunswick; David 
Stephens. New Brunswick. 

Monmouth— Henry Mitchell, Asbury Park; D. McLean Forman, 
Freehold: Edwin Field. Red Bank; P. B. Pumyea. Allentown ; 
George F. Wilbur, Asbury Park ; Samuel Johnson. Asbury Park ; 
Cyrus Knecht, Matawan. 

Morris— Levi Farrow, Hackettstown ; Cuthbert Wigg, Boonton ; 
James Douglass, Morristown ; Britton D. Evans. Morris Plains ; A. A. 
Lewis, Morristown. 

Passaic— W. B. Johnson. Paterson ; P. A. Harris, Paterson ; C. H. 
Scribner. Paterson ; Robert M. Curts. Paterson ; James M. Stewart, 
Paterson ; Andrew F. McBride. Paterson. 

Salem— B. A. Waddington, Salem ; W. H. James. Pennsville. 

Somerset— S. O. B. Taylor, Millstone ; J. P. Hecht, Raritan ; 
A. L. Stillwell, Somerville. 

Sussex— B. W. Ferguson, Beemerville. 

Union— Alonzo Pettit, Elizabeth; E. B. Silvers, Rahway; 
J. Ackerman Coles, Scotch Plains ; T. H. Tomlinson, Plainfield ; 



MINUTES. 45 

James S. Green. Elizabeth ; Thos. N. McLean. Elizabeth ; Norton L. 
Wilson. Elizabeth ; W. U. Selover, Rahway. 
Warren -J. M. Reese, Phillipsburg. 

The Honorary Membership was represented by Cyrus 
F. Brackett, of Princeton. 

The following were present as invited guests: 

Chas. P. Noble, J. M. Baldy, Frank Fisher. J. P. Crozier Griffith, 
Judson Daland and Savary Pearce, of Philadelphia ; J. J. Kinyoun. of 
Glenolden ; R. B. Fitz Randolph, of Trenton ; William M Leszynsky, 
of New York, and W. M. Troy. Portsmouth, Va. 

The following annual delegates and corresponding 
members were present : 

Atlantic — Philip Marvel, Walter Reynolds, Theodore Senseman. 
Atlantic City. 

Bergen— J. E. Pratt. Dumont. 

Burlington— Alex Marcy, Jr.. Riverton ; J. Clifford Haines, Vin- 
centown ; John J. Flynn, Mount Holly. 

Camden— P. M. Mecray, J. W. Fithian, Emma M. Richardson 
and William I. Kelchner, of Camden. 

Cumberland — D. H. Oliver. S. D. Mayhew. Bridgeton ; H. G. 
Miller, G. E. Day, Millville; Ellsmore Stites. Bridgeton. 

Essex— Thomas N. Gray, East Orange; Walter S. Washington, 
Chas. V. Burke. Edward H. Hamill, Newark; J. F. E. T^treault, 
Orange; William J. Roeber. Wm. H. White, Edward E. Worl. 
William Buerrman. Charles Titus, Lars T. Wendelboe, Newark; 
S. G. Lee. East Orange; Maurice Asher, W. P. Eagleton, Sarah R. 
Mead, Isabel M. Geddes, Frank W. Pineo, John Hemsath, E. S. 
Sherman. Thos. W. Loweree, Newark ; Calister V. Luther, South 
Orange. 

Gloucester— S. F. Stanger, Harrisonville. 

Hudson— W. F. Faison. 1. Pyle. H. H. Brinkerhoflf, J. P. Henry, 
Jersey City ; S. A. Heifer, Hoboken, A. A. Strasser, Arlington ; M. F. 
Squier, Harrison. 

Hunterdon — F. S. Grim, Baptistown ; A. B. Nash, Frenchiown ; 
Geo. W. Bartow. Three Bridges. 

Mercer— A. L Hunt. Hamilton Square; M. W. Reddan, J. F 
Chattin. David F. Weeks, F. G. Scammell, F. V. Cantwell, B. W. 
McGalliard, H. G. Norton, Wm. S. Lalor, Trenton. 



46 MEDICAL SOCIETY OF NEW JERSEY. 

Middlesex— A. C. Hunt, Metuchen; Wm. E. Ramsey. F. C. 
Henry, F. Martyn Brace, John L. Lund, Perth Amboy ; W. M. Moore, 
New Brunswick; Ira T. Spencer, Woodbridge. 

Monmouth— Harvey Brown, I. B. Long, Freehold ; W. W. Bev- 
eridge, John Taylor, J. F. Davison, Reginald S. Bennet, J. L. Coleman. 
Asbury Park ; S. J. Wooley, Long Branch ; D. D. Hendrickson, 
Middletown ; J. B. Wainwright, Manasquan. 

Morris— Eliot Gorton, Sunrimit ; L. L. Mial, R. D. Baker, Morris 
Plains ; A. E. Carpenter, Boonton. 

Passaic— D. T. Bowden, H. Kip. J. W. Smith, E. J. Marsh, Jr.. 
F. E. Agnew, H. V. Pike, John C. McCoy, Paterson ; F. F. C. Demar- 
est, Passaic. 

Salem— C. M. Sherron, J. F. Smith, R. M. Davis, Salem ; J. R. 
Richards, Fort Moit. 

Somerset— J. Meigh, Bernardsville. 

Union— E. B. Grier, Elizabeth ; J. B. Harrison. Westfield ; F. C. 
Ard, Plainfield. 

Warren— Wm. J. Burd, Belvidere; Frank W. Curtis. Stewarts- 
ville. ■ 

The following Permanent Delegates were absent : 

D. A. Currie, Englewood ; Onan B. Gross, Camden ; Wm. H. Iszard, 
Camden ; Randolph Marshall, Tuckahoe ; T. J. Smith, Bridgeton ; 
O. H. Adams, Vineland; Wm. Rankin, Newark; Geo. A. Van Wag- 
enen, Newark ; Henry B. Whitehorn, Verona ; Geo. C. Laws, Pauls- 
boro ; J. A. Exton, Arlington ; Elmer Barwis, Thos. H. Mackenzie, 
C. F. Adams and H. B. Costil. Trenton ; J. G. Wilson, Perth 
Amboy; F. C. Price. Imlaystown ; I. W. Condict, Dover; Stephen 
Pierson, Morristown ; F. E. Flagge, Rockaway ; Calvin Anderson, 
Madison ; Geo. A. Balleray, Paterson ; J. L. Leal, John T. Gilson and 
M. A. Mackintosh, Paterson ; Henry Chavanne, Salem ; Mary E. 
Gaston, Somerville ; E. Morrison, Newton. 

The following Permanent Delegates have been absent 
from two consecutive annual meetings : 

Wm. Rankin, Newark ; Henry B. Whitehorn, Verona ; Geo. C. 
Laws, Paulsboro ; J. G. Wilson, Perth Amboy ; F. E. Flagge, Rock- 
away ; Calvin Anderson, Madison. 

On motion of Dr. H. W. Elmer the reading of the 



MINUTES. 47 

minutes of the last annual meeting was dispensed with. 
Dr. H. W. Elmer presented the report of the Com- 
mittee on Ethics and Judicial Business. 

REPORT OF THE COMMITTEE ON ETHICS. 

The American Medical Association, at the meeting held in New 
Orleans, made the following declaration : *' The broadest dictates of 
humanity should be obeyed by physicians whenever and wherever 
their services are needed to meet the emergencies of disease or 
accident." 

In view of this decision, the Committee on Ethics in the case of 

the District Medical Society of Monmouth County against D. McL. 

Forman, M. D . would respectfully report that Dr. Forman has not 

been guilty of any conduct in violation of the present code of ethics. 

Respectfully submitted, 

H. W. Elmer, Chairman. 

ASBURY Park, N. J.. June 23d. 1903. 

On motion of Dr. Archibald Mercer, the report was 
accepted. 

Dr. Elmer then presented as a supplementary report a 
communication from the Atlantic County Medical 
Society regarding the conduct and standing of one Dr. 
H. Walter, as follows: 

June 15, 1903. 
W. J. Chandler, M. D.. 

Sec'y Medical Society of New Jersey. 

Dear Doctor : — At a recent meeting of the Atlantic County Medical 
Society, the following resolution was adopted : 

•• Resolved, That it is the sense of the Atlantic County Medical 
Society that the charter under which Dr. H. Walter, of Atlantic City, 
in now granting diplomas is inconsistent with the present statutes 
regulating the practice of medicine in this State." 

Therefore, we petition the Medical Society of New Jersey to take 

such action as in its judgment will be consistent with the question in 

point. 

Fraternally yours, 

E. GUION. Secretary, 



48 MEDICAL SOCIETY OF NEW JERSEY. 

A similar communication was received from A. Burton 
Shimer, Secretary of the Atlantic City Academy of Med- 
icine. 

Dr. Pennington : It is well known to most of you that 
we are in the midst of a fight, and while we are not 
now asking the backing of the State Society, we feel sure 
that ultimately the matter will reach the Medical Society 
of New Jersey. Of course, we shall be grateful for any 
assistance the State Society may give us. Dr. Walter 
pretends to be a graduate in medicine of the University 
of Pennsylvania, but he has been shown to be a gradu- 
ate in veterinary medicine there. He stands at the top of 
the irregular practitioners, and is backed by the wealthy 
residents of Atlantic City, and is fighting this question 
stubbornly. 

Dr. Elmer: The Judicial Committee has not had an 
opportunity to pass upon the question. Dr. Walter has 
already been arrested, and it is expected that his trial 
will come up in the September term of the court of 
Atlantic County. 

Dr. C. Shepherd : I move that this petition of the 
Atlantic County Medical Society be referred to the 
Judicial Committee for investigation. Seconded by 
Dr. G. E. Reading and carried unanimously. 

On motion of Dr. Reading, it was decided that the 
report of the Committee on Honorary Membership lie 
over until to morrow, owing to the absence of the chair- 
man of that committee. 

Drs. J. P. Hecht, G. E. Reading and D. M. Skinner 
were appointed as the Auditing Committee. 

Dr. Wilbur, of Asbury Park: I have just received a 
communication from the Acting Mayor of this city con- 
taining resolutions, passed by the Common Council last 
night, welcoming the Medical Society of New Jersey to 
Asbury Park. The resolutions were read. 



MINUTES. 49 

On motion, the communication was received and placed 
on file. 

On motion of Dr. Reading, the report* of the Treasurer, 
Dr. Archibald Mercer, was made the next order of busi- 
ness. After reading the report the Treasurer recom- 
mended that the assessment on the county societies for 
the ensuing year be one dollar per capita. 

Dr. William Elmer, of Trenton, moved that the report 
be received and referred to the Auditing Committee. 
Seconded and carried. 

Dr. William Elmer: I do not know that I am ready 
to accept the recommendation of one dollar as the tax on 
the county societies. Whether or not the assessment 
should be kept up at two dollars is a question. I under- 
stand that after the payment of these bills for the Trans- 
actions there will only be the narrow margin of $200. I 
personally believe it is a mistake to vary the assessment 
from year to year. 

Dr. Mercer: I think there will be a balance of six or 
seven hundred dollars after all the bills this year have 
been paid. I, therefore, think an assessment of one 
dollar on the county societies is sufficient. 

Dr. G. E. Reading : I move to adopt the recommend- 
ation of the Treasurer. I would not say that it was 
an assessment of only one dollar that put us behind, 
but it was not having any assessment at all for two or three 
years that did this. We have been collecting one dollar 
from the county societies as the annual tax for the last 
two years, and, as a result, the treasury is at present in 
excellent condition. Seconded and carried. 

Dr. Mercer: I recommend that the bill of the Com- 
mitte on the Revision of the By-Laws be ordered paid. 

Dr. Reading: I move that the bills presented by the 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 
4 



50 MEDICAL SOCIETY OF NEW JERSEY. 

Treasurer and recommended to be paid be ordered paid. 
Seconded. Carried. 

The Treasurer : We have among our assets four, per 
cent. U. S. bonds which will fall due in January, 1907. 
These bonds are constantly depreciating in market value, 
and have already been called in and exchanged in most 
instances. I, therefore, move that a committee of three 
be appointed with power to sell these bonds and reinvest 
the money in such securities as they deem fit. Seconded 
by Dr. W. J. Chandler and carried unanimously. 

The President appointed on this committee. Dr. Archi- 
bald Mercer, of Essex; Dr. W. B. Johnson, of Passaic, 
and Dr. T. R. Chamb ers, of H udson County. 

Dr. Philip M ar^i^!r^^r(t]c""'Cky : Your Committee 
on Revision of^rapConstitution^tvd'jfo^-Laws has labored 
faithfully and pner«tiGalWQfQ^±wo^»i^ to give you a 
revision that wl||meet the neeas andldemands of your 
Society. In v\attfyer particulars^^ have failed you 
must judge. In Dtiftefi ^tAiiro Afer before you to-day 
for your consideration the Committee especially asks that 
you will take up this matter and act upon it, and will 
not so far ignore their efiforts as to offer a motion to put 
it aside. 

Dr. Marvel then presented the report, which had been 
printed for distribution. 

Dr. W. J. Chandler: I move that the Society begin at 
this time the consideration of this report. Seconded by 
Dr. Pennington. 

Dr. W. B. Stewart, Atlantic City : I move as an 
amendment that the Chairman present simply the changes 
that have been made in the printed report. Seconded. 

Dr. Pennington withdrew his second to the original 
motion, leaving Dr. Stewart's motion before the house. 
Jt was carried. 



MINUTES. 51 

Dr. Marvel then read the changes in the printed report 
as follows : 

Article IV.. Section i, first line, insert "only" after "shall be com- 
posed;*' third line, insert "Associate" between " and " and "Dele- 
gates," and strike out **ex Officio.** 

Strike out first three lines of Section 2. 

Article IV., Section 5, first line, change "of," after •* Delegates," to 
" to." 

Article IV., Section 6, second line, insert " membership of the 
Medical Society of New Jersey " after " included in the," and strike 
out * foregoing offices ; " in the third line, after " and Reporters are," 
insert " hereby constituted Associate," and strike out " Ex officio" 
after " Delegates ; " in the fifth line, change " or/' after " general," to 
*'and." 

Article IV., Section 7. first and second lines, change -practicers of 
medicine who have risen to pre-eminence in the profession," to 
" physicians and surgeons who have attained distinction in the pro- 
fession ; " add to third line, " after the recommendation of the Com- 
mittee on Honorary Membership." 

Strike out Section 8, of Article IV. 

Article IV., Section 9, third line, change " Society " to " President ; " 
in the fifth line, insert " members for the day " after " elected," and 
change " for the day only," after "vote," to "of the members." 

Article V., Section 1 , first line, after " legislative," insert " and the 
Board of Trustees the executive." 

Article V., Section 2, first line, change " may be " to " are ; " in the 
third line strike out " and ; " third and fourth lines, change "also the 
ex-Chairmen of the different sections when created," to " Chairmen 
of all committees requiring a written report, who have complied with 
the Constitution and By-Laws." 

Article VII., Section 2, first line, strike out "have power to;" 
second and third lines, strike out " when the best interest of the Soci- 
ety is to be promoted thereby ; " in fourth line, change comma after 
•• Societies" to period ; change " and," after " Societies," to " When ; " 
in fifth line strike out " When approved." 

Article IX., Section 3, third line, change "morning" to "after- 
noon." 

Article X., first line, insert " Section i " before " Funds ; " in next to 
last line, change "such," before ••purposes," to '"no;" "as," after 



52 MEDICAL SOCIETY OF NEW JERSEY. 

" purposes," to " than," and sti ike out " but " at end of line ; take last 
line away from Section i and let it constitute Section 2. 

Article XIl, change "pleasure," at end of second line, to "discre- 
tion." 

Article XIII., make a new Section i, as follows: Section i. For 
a period of two years, and no longer, amendments to this Constitution 
may be offered by any member on giving written notice thereof of the 
proposed amendment, to the Recording Secretary of this Society (and 
to each Component Society) ninety days previous to the annual session, 
provided a two-thirds vote shall be required for its adoption, and pro- 
vided, after two years Section i of Chapter XIII. shall be inoperative 

Article XIII., insert "Section 2" at beginning of first line, and in 
the fourth line change "that it," after "and," to "said amendment." 

By-Laws, Chapter I.. Section i, second line, change "Ex-o^ct'o*' to 
"Associate; " fourth line, change " privilege " to " provision." 

Chapter i. Section 4, first line, change " Permanent " to "All," and 
add to second line, " and failure to do so will be considered equiva- 
lent to absence." 

Chapter II., Section 2, first line, after "or," insert "of." 

Chapter III., Section 4, third line, insert "Third Vice President'' 
before "and invited orators." 

Chapter III., Section 5, first line, insert "and reports " after "all 
papers," and add to last line, " Permission to publish in medical 
journals may be granted by the Committee on Publication." 

Chapter IV., strike out all of Section i after the words "annual 
orations," in fifth line. 

Chapter IV., Section 2, fourth line, after "provided" insert "(1) 
that ; " add to last line, " and (2) that each component society send 
at least one annual delegate." 

Chapter IV, Section 3, third line, change " sit as members of" to 
" be seated in." 

Chapter V.. Section 2, change " the annual," at beginning of second 
line, to *• all ; " in third line, change " after the adjournment " to " at the 
close of the first session ; " in fourth line, change comma after " com- 
mittee " to a period ; change " and," after "committee," to " When 
approved by the House of Delegates ; " in the two last lines, change 
" within twenty minutes after the adjournment of the session " to 
" without said certificate they can not be approved by the House of 
Delegates." 



MINUTES. 53 

Chapter V., Section 5, second line, change " a majority " to •* iwo- 
thirds." 

Chapter V., strike out Section 6. 

Chapter VI., Section i, in the second line after •* New Jersey and " 
insert ** of." 

Chapter VI., Section i, strike out all of last line after " By-Laws." 

Chapter VI., Section 5, twelfth line, change " assistance " to " assist- 
ants; " in the fifteenth line, change " New Jersey Medical Society " to 
•• Medical Society of New Jersey." 

Chapter VII., first line, change "Section 5 "to "Section i," and 
change " required," after shall be," to " the privilege ; " eleventh line, 
change " be considered equivalent to " to " constitute ; " twelfth line, 
change comma after " Credentials " to a period ; thirteenth line, 
change " which," at beginning of line, to " A," and " will prohibit the 
said delinquent reporter from " to " to do so will constitute a delin- 
quency and will be so treated by the Committee on Credentials, which 
will decline to give said delinquent Reporter ; " strike out all after •* at 
that session " in last two lines. 

Chapter XV., Section 3, next to last line, change "entitled" to 
" eligible ; " last line, change " this," before " Society," to ** their." 

Chapter XV., transpose Section 3 and Section 4 ; Section 3 be- 
c >ming Section 4, and Section 4 becoming Section 3. 

Chapter XV., Section 7, second line, change " shall," after " his 
name," to " may ; " in last line, strike out " without cost to himself." 

There being some doubt as to whether the discussion 
(»f the By-Laws was in order at this time, and some 
members desiring that certain parts be explained, it was 
moved by Dr. Chandler that the members be allowed to 
discuss the Constitution and By-Laws and ask for explan- 
ations. Seconded. Lost. 

Dr. Alexander McAIister, Camden, presented the report 
of the Committee on Business.* 

On motion, the report was received and referred to the 
Standing Committee for publication in the Transactions. 

Dr. H. W. Elmer read the following petition from Dr. 
Irwin H. Hance and others for permission to organize an 
entirely new county society in Ocean County: 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



54 MEDICAL SOCIETY OF NEW JERSEY. 

Lakewood. N. J.. May 25th, 1903 
To the Mtdical Society of the State of New Jersey : 

Gentlemen: — We, the undersigned, being licensed practitioners 
in the County of Ocean, which at the present time has no district 
society, wish to organize said society and be represented in the State 
Society. 
We do respectfully request that you grant us that privilege. 
Irwin H. Hance. A. M. Heron. 

William G. Schauffler. Paul T. Kimball. 

V. M. DiSBROW. E. C. DiSBROW. 

Geo. W. MacMillan. Frank Brouwer. 

Harold Pittis. Ralph R. Jones. 

The Pres^'dent : If there is no objection, this commun- 
ication will be referred to the Judicial Council. 

Dr. W. J. Chandler: As this comes /r^;« the Judicial 
Council, and they may perhaps be in doubt as to what 
action should be taken, I think they would welcome some 
instructions from the Society. It would be well to advise 
the petitioners from Ocean County to proceed to reorgan- 
ize the old society and come here next year with a dele- 
gation. Ocean County Society is not dead, but only 
suspended, according to our By-Laws. Its records appear 
to be lost. I, therefore, move that the physicians if 
Ocean County have the authority of this Society to 
reorganize and proceed regularly under their present 
charter. Seconded and carried unanimously. 

Adjourned at i.io P. M. 



AFTERNOON SESSION. 

The meeting was called to order by the President at 
3.15 P. M., and the session was opened with prayer by 
the Rev. George A. Gensmer, of Asbury Park, the pastor 
of the Lutheran Church. 

Dr. H. W. Elmer: As Dr. Frank Brouwer, one of the 



MINUTES. 55 

members of Ocean County Society, is present, I move 
that he be invited to sit with us as a corresponding 
member. Seconded and carried. 

Dr. A. Mercer: I move that Dr. Phillip Y. Eisenberg, 
of the Medical Society ot the State of Pennsylvania, be 
invited to sit with us as a corresponding member. 

On motion of Dr. Chandler, Dr. J. N. McCormack, of 
Kentucky, was invited to sit with the Society as a guest, 
and the same motion was made with regard to Dr. Savary 
Pearce. 

On motion of Dr. C. J. Kipp, this invitation was 
extended to all members of recognized medical societies 
in good standing. 

Dr. John Taylor, of Asbury Park, presented the report 
of the Committee of Arrangements.* 

On motion, the report was accepted. 

Dr. E. W. Hedges presented the report of the Corres- 
ponding Secretary.* 

On motion, it was referred to the Committee on Publi- 
cation. 

Dr. W. J. Chandler presented the report of the Record- 
ing Secretary.* 

On motion, the report was accepted and ordered pub- 
lished in the Transactions. 

Dr. Charles Young, Newark, presented the report of 
the Committee on Tuberculosis as follows : 

The Committee on Legislative Action on Bovine Tuberculosis 
respectfully reports that during the past year there has appeared to 
the Committee no reason for meeting. There was no bill introduced 
into the Legislature of the State in regard to tuberculosis in cattle, 
nor as far as known was there any reference made to the subject 
during the late session. 

Respectfully submitted, 

Charles Young, Chairman. 
ASBURY Park, June 23. 1903. 

All reports, papers, etc., marked thus (*) will be found in the Append! v. 



56 MEDICAL SOCIETY OF NEW JERSEY. 

On motion of Dr. Mercer, the report was accepted and 
referred to the Committee on Publication. 

The consideration of the proposed revision of the Con- 
stitution and By-laws was then taken up. 

Dr. C. J. Kipp: I move that we dispense with the 
reading of this report, as it has been already printed and 
distributed to the members. Seconded by Dr. E. J. Ill 
and carried. 

Dr. Kipp: In view of the fact that this committee 
has been working on this subject for the past year, and 
its members have worked assiduously, I move that this 
report, as presented, be accepted as the Constitution and 
By-Laws of this Society. Seconded. It was then moved 
to amend by adding ** to take effect at the close of this 
meeting." Seconded by Dr. A. McAlister. 

The motion as thus amended was carried. 

Dr. Cornelius Shepherd : I am aware that I am out 
of order, but as a member of this Society I think I have 
the right to be heard. I have attended this Society for 
over forty years, and here to-day, in the twinkling of an 
eye, without an opportunity for a word of protest, the 
Constitution of the Medical Society of the State of New 
Jersey has been overturned, defeated, and a new one 
adopted. 

The President : The gentleman is out of order. He 
can move for a reconsideration if he so desires. 

Dr. Kipp : I move that the thanks of the Society be 
extended to the committee which has presented to-day 
this revised Constitution and By-laws. Seconded and 
carried. 

The President (To Dr. P. Marvel): I beg, sir, to 
extend to you and your committee the thanks of the 
Society for your very successful work. 

AH reports, papers, etc.. marked thus (") will be found in the Appendix. 



MINUTES. 57 

Dr. Marvel : On behalf of the committee I am very 
glad to accept the thanks of the Society. 

Dr. R. C. Newton, for the Committee on Dr. Newton's 
Paper, reported progress. 

Dr. T. Y. Sutphen presented the report of the Com- 
mittee on the Abuse of Medical Charities.* 

On motion, the report was received. 

Dr. W. B. Johnson : I should like to suggest a means 
of arriving at the desired result. It is to work through 
the charity organization societies of the State. There 
are already organized in several of the larger cities, charity 
organization societies, not for the purpose of extending 
charity, but for doing exactly as this committee has sug- 
gested, i, e,, investigating cases supposed to need chari- 
table aid. Recently there has been organized in the City 
of Paterson such a charity organization society ; 1 am 
sure there is such a society in Newark and one in the 
Oranges. As the abuse of medical charity occurs in the 
larger cities, it is fair to presume that these societies will 
be organized in time in every large city in the State. It 
is to be supposed that the officers of our institutions will 
prepare a daily list or a weekly list for the charity 
organization society, so that an investigation may be 
made of these applicants. It seems to me that an organ- 
ized effort of this character is much better than the 
method suggested by the committee, i. e,, that the sev- 
eral charitable institutions employ their own officer. 
Organized effort in such work is certainly much more 
effective and satisfactory than individual effort, particu- 
larly as considerable experience is necessary to do this 
work well. It is easy for people who are to be investi- 
gated to impose upon all except such experienced work- 
ers. I hope this suggestion will be added to the com- 
mittee's report before publication. 

All reports, papers, etc., marked thus (•) will be found in the Appendix. 



58 MEDICAL SOCIKTY OF NEW JERSEY. 

Dr. Paul M. Mecray, Camden : I have observed the 
practical workings of this scheme, and it has not been 
satisfactory. At the Cooper Hospital, at Camden, we 
have tried to carry out this plan. It has been found that 
a very large number of the names and addresses are ficti- 
tious. If the people are not worthy they do not mind 
such investigations, whereas the very people we should 
desire to help feel very much hurt. I hope the plan \\'\\\ 
be abandoned in Camden. 

Dr. C. J. Kipp. Newark : I have been working for the 
past thirty-five years with a charitable institution, and my 
experience is that the abuse of medical charity is entirely 
in the hands of the medical profession. If physicians 
work in institutions which will not endeavor to restrict 
this abuse they should resign. 

On motion, the report was adopted. 

The Secretary: I should like to ask the committee if 
it desires to be continued. 

The President : The committee is discharged unless 
a motion is made to continue it. 

Dr. William Elmer : I move that a copy of the 
Constitution and By-Laws be printed by the Com- 
mittee on Revision and be sent to every member of 
every District Society, the expense of the same to be 
defrayed by the general fund of the Society. Seconded. 

Dr. William J. Chandler: I move to amend by add- 
ing " that the bill for the same shall be paid by the 
Treasurer on presentation," instead of being laid over for 
one year. Accepted by Dr. Elmer. 

Dr. P. Marvel : This motion is not necessary, for the 
Board of Trustees can attend to such matters ad interim. 

Dr. Charles Young, Newark: I cannot see the use of 
putting the Society to the expense of such publication, 
for the new Constitution and By-Laws will be published 
in the volume of Transactions. 



MINUTES. 59 

Dr. Chandler: I endorse Dr. Young's views — that 
the expense of a special edition and its distribution is 
unnecessary. 

The motion of Dr. Elmer was then put and lost. 

Dr. Joseph Tomlinson, of Bridgeton, presented the 
report of the Committee on Dr. Tomlinson's paper on 
" The Present Methods of Education from the Standpoint 
of the Physician."* 

Dr. A. K. Baldwin, Newark : I move that this report 
be received and that the recommendations made be 
indorsed by the Society. 

Dr. C. J. Kipp: I second the motion, and would 
amend it by adding that these recommendations be car- 
ried out by the present committee. 

The motion, as thus amended, was carried. 

On motion of Dr. Newton, Dr. Savary Pearce, of Phil- 
adelphia, was requested to address* the Society on the 
subject of Dr. Tomlinson's paper. 

Dr. Charles J. Kipp presented the report of the Dele- 
gates to the American Medical Association. He said: 
We were at the meeting of the House of Delegates, the 
proceedings of which have been published in the Journal 
of the American Medical Association. The most im- 
portant thing done by that body was the changing of 
the Code of Ethics, now known as ** The Principles of 
Medical Ethics.'* I can not do better than refer you to 
the explanatory preface of that document, as printed in 
the Journal of May 1 6, page 1379. (Reads this). I may 
add that the Committee, without any solicitation from 
your delegates, selected Atlantic City as the place for the 
next meeting of the American Medical Association. 

On motion of Dr. P. Marvel, Dr. McCormack, of Ken- 
tucky, was granted the privileges of the floor. 

All reports, papers, etc., marked thus (•) will be found in the Appendix. 



6o MEDICAL SOCIETY OF NEW JERSEY. 

Dr. McCormack said : I am glad to see that New 
Jersey is the twenty-seventh State that has now adopted 
the Constitution and By-Laws formulated and recom- 
mended by the American Medical Association. At the 
New Orleans meeting this number was not so large, but 
the States have fallen into line very rapidly, your State 
being the twenty-seventh. 

It gives me great pleasure as the 'representative of the 
American Medical Association to extend words of very 
cordial greeting and encouragement to tne oldest State 
medical society in the United States. With your great 
work I am more or less familiar, and I have every reason to 
believe that the experience which has been repeated over 
and over again in States which reorganized last year will 
probably be repeated here. I understand that by your 
^ction to-day you have increased your membership almost 
four-fold, adding the membership of the county societies 
to that of the State organization. In my own State, 
Kentucky, we had 400 members on our roll when we 
adopted this plan ; at the end of the year we had ^2 
organized county societies and 1,600 members in good 
standing on our roll. The enthusiasm and the spirit of 
harmony and unity which pervaded that meeting were of 
far greater significance than could be accounted for by 
any mere increase in numbers. 

The work which the American Medical Association has 
undertaken, and asks the State societies to undertake, is 
not Utopian, but it involves much self-sacrificing work 
on the part of your Council. It occurs to me that before 
this Society adjourns provision should be made for 
the appointment of and organization of your Council for 
this year. Unless this is done you lose a year in the 
work of organization, and 1, therefore, suggest this for 
your consideration. This is better than waiting until 



MINUTES. 6l 

next year for such appointment to be done by your House 
of Delegates. If the work is to be made as far-reaching 
in New Jersey as it has been in the other States, it should 
be begun as soon as possible. What has occurred in 
Kentucky has occurred in Michigan, Tennessee, Arkansas 
and many other States, and I am sure I have good reason 
for congratulating you on the harmony and unity of 
your work, and if this spirit continues the same great 
results will come to the profession of your State which 
came to those who at first predicted that this was only an 
experiment. 

Dr. Eisenberg, Delegate from the Medical Society of the 
State of Pennsylvania, said : It gives me great pleasure to 
make my bow to the oldest State Medical Society in the 
Union. I had no idea when I came here that your 
Society was so old. We, in Pennsylvania, can only 
number fifty-seven years, or about the age of the Amer- 
ican Medical Association. I am glad to be with you, 
and, from the spirit which has been manifested this after- 
noon, I know your deliberations will be of profit. 
Situated as you are between the two great medical 
centres of New York and Philadelphia, and coming in 
contact with the leading investigators and scientific men 
of those centres, I know you must occupy the front rank 
in discussing the questions coming up before you. I 
know I shall go home after a pleasant and profitable time. 

On motion of Dr. McAlister, the regular order of busi- 
ness, with the exception of the President's address, was 
then taken up. 

The Secretary then read the list of nominees for per- 
manent delegates recommended by the Committee on 
Credentials. (Previously reported.) 

Dr. C. Shepherd : There seems to be some misappre- 
hension with regard to Mercer County. We had a meet- 



62 MEDICAL SOClETy OF NEW JERSEY. 

ing and selected three permanent delegates, Dr. Franklin, 
Dr. Clark and Dr. Bruyere. Why the secretary of our 
county society has not sent the proper credentials to the 
Secretary of the State Society I do not know. One certifi- 
cate (that of Dr. Franklin) has been handed to me with 
the statement that it is not in proper form, yet it 
is just the form that has always been employed by our 
Society. If there is a special form our Secretary should 
have it. 

The Secretary : Dr. Shepherd is mistaken in his state- 
ment that the form of Dr. Franklin's certificate is the 
same as that hitherto accepted from Mercer County. 
The form is printed at the bottom of page 15 of the 
By-Laws. I explained to Dr. Franklin in what way his 
credentials differed from this form. This form has been 
printed in the By-Laws for eight years, and hence the 
county societies are at fault if they fail to comply with it. 

Dr. Ireland : Drs. McAlister and Sherk were elected at 
the same meeting and their credentials were supposed to 
have been given at the same time, yet Dr. McAlister's 
name is on the list and that of Dr. Sherk is not. 

The Secretary: Dr. McAlister sent his certificate about 
three weeks ago ; Dr. Sherk's has not been presented 
until this very moment. It is correct in form and can 
be accepted. 

Dr. E. J. Marsh: I move that the Secretary be author- 
ized to cast the ballot of the Society for the permanent 
delegates according to the list as read, with the addition 
of the name of Dr. Sherk. Seconded by Dr. Mercer 
and carried. The ballot was cast and they were declared 
elected. 

Dr. H. W. Elmer, Bridgeton, presented the report of 
the Standing Committee.* On motion, the report was 
received. 

All reports papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 63 

Dr. Skinner presented the report of the Auditing 
Committee, to the effect that they had examined the 
books and vouchers of the Treasurer and had found the 
same correct. 

On motion, the report was accepted. 

Dr. W. H. Ireland, Camden, presented the report on 
the *' Progress in Medicine and Therapeutics.'** 

On motion of Dr. McAlister, it was accepted and 
referred to the Committee on Publication. 

On motion of Dr. McAlister, Dr. J. L. Leal's paper on 
*' Progress in State Medicine and Hygiene "* was ordered 
read by title and referred to the Committee on Publi- 
cation. 

On motion of Dr. McAlister, Dr. B. A. Waddington 
was permitted to read at this time his paper on " Pro- 
gress in Laryngology.*'* 

On motion, his report was accepted and referred to the 
Committee on Publication. 

Dr. Charles Young, Newark, read the report on ** Pro- 
gress in Surgery.'** 

On motion, the report was received and referred to the 
Committee on Publication. 

At the request of Dr. B. C. Pennington, Atlantic City, 
his paper, "Serum Therapy in the Treatment of 
Tetanus," was read by title and referred to the Com- 
mittee on Publication. 

The resignations of Dr. Alexander Marcy, Riverton, 
and Dr. A. W. Taylor, Beverly, as permanent delegates 
were read and, on motion of the Secretary, were 
accepted. 

On motion, adjourned at 6 P. M. 



All reports, pnpers, etc., marked thus (*) will be found in the Appendix. 



64 MEDICAL SOCIETY OF NEW JERSEY. 

EVENING SESSION. 

The Society reconvened at the call of the President 
dt 9 P. M. 

Dr. Philip Marvel, Atlantic City, reported a ** Case of 
Amoeba-Coli Dysentery."* It was discussed by Dr. 
Daland, Philadelphia, and Dr. Marvel made some closing 
remarks.* 

Dr. E. L. B. Godfrey, Camden, delivered the Presi- 
dent's annual address, taking for his theme, **The 
Educational Standards of the Medical Profession of 
New Jersey, Past and Present."* 

At the conclusion of this address. Dr. McAlister intro- 
duced Dr. Daniel Strock, of Camden, who, he said, had 
been selected by the staff of the Cooper Hospital, 
Camden, to present a gavel to Dr. Godfrey. 

Dr. Daniel Strock, addressing the President, Dr. 
Godfrey, said : 

Your colleagues of the Cooper Hospital attending staff delegated 
me to present their compliments on this occasion, when you have 
attained that position which is the laudable aim of every medical 
man in the State of New Jersey, the Presidency of the Medical 
Society of New Jersey. In doing this they have not lost sight of 
the fact that the honor has come to you as the member of a 
family that has existed for a number of years, and that has labored 
together in the cause of humanity. They have viewed your career 
for many years with great pleasure up to this pleasant culmi- 
nation this evening. You have been instrumental in the Cooper Hos- 
pital in doing one of the grandest works carried on in this State, and 
they have learned to esteem and love you. You have been successively 
honored by your own profession, not only in the city and county, but 
in the state. As President of the Camden City Medical Society, of 
the Camen County Society, and of the New Jersey Sanitary Associa- 
tion, you have occupied important positions, and have filled them with 
great ability. Your address to-night has been along the lines which 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 65 

have made you famous throughout this State. Your work upon the 
State Medical Examining Board has been very satisfactory to your col- 
leagues, and also to the profession of the State. You have stood as a 
bulwark between the medical profession and the quack, pretender, 
and the charlatan. 

As a culmination of this work, the medical profession has seen fit to 
raise you to this exalted position of President of the Medical Society 
of New Jersey. We. therefore, desire to present to you. as a slight 
token of esteem, a gavel made of the wood of the hospital in which 
you have done such noble work. There have been changes made in 
the hospital recently, and we have seized this opportunity to take 
some of the wood and make it into this gavel. In asking you to 
accept it we do so with the expression of our love and esteem, and we 
trust and know you will use it in the same spirit of fairness that has 
ever characterized your career. 

Dr. Godfrey : Dr. Strock, I hardly know what to say in response 
to you and my colleagues for those kind words and for their gift. I 
assure you that I accept this token with the heartiest appreciation, 
and hope you will present to the staff the assurance of my highest 
regard for them. 

Dr. J. M. Rector, Jersey City, read a paper, ** Gynecol- 
ogy ; Its History and Development."* It was discussed 
by Dr. W. F. Faison, of Jersey City.* 

The President appointed Dr. Armstrong to represent 
Bergen County in the Nominating Committee, and the 
Secretary announced the names of the Nominating 
Committee as follows : 

Atlantic — Theodore Senseman, Atlantic City. 
^^^^«— Samuel E. Armstrong, Rutherford. 
Burlington— PCi&xdJi^tx Marcy, Jr., Riverton. 
Camden — Paul M. Mecray, Camden, Chairman, 

Cape May — 

CumSerland—Jostph Thomlinson, Bridgeton. 
Essex — Edward J. Ill, Newark. 
Gloucester — Eugene T. Oliphant, Bridgeport. 
Hudson — H. H. Brinkerhoff, Jersey City. 



AH reports, papers, etc., marked thus (*) will be found in the Appendix. 
5 



66 MEDICAL SOCIETY OF NEW JERSEY. 

Hunterdon — G. W. Bartow, Three Bridges. 
Mercer — Wm. S. Lalor, Trenton. 
Middlesex — A. C. Hunt, Metuchen. 
Monmouth — H. S. Brown. 
Morris — James Douglass, M orristown. 
Passaic — Henry Kip, Paterson. 
Salem — Wm. H. James, Pennsville. 
Somerset ^K, L. Still well, Somerville. 
Sussex - B. W. Ferguson, Beemerville. 
Union — J. B. Harrison, Westfield. 
Warren — Frank W. Curtis. Stewartville. 

Dr. Daniel Strock, Camden, read a paper on "Osteo- 
pathy."* 

On motion, the paper was accepted and referred to the 
Committee on Publication. It was discussed* by Dr. R. 
C. Newton, Montclair. 

On motion, the Society adjourned at ii P. M. 



SECOND DAY— WEDNESDAY JUNE 24TH. 

MORNING SESSION. 

The meeting was called to order by the President at 
10 A. M. 

On motion of Dr. P. Marvel, Drs. Daland and Noble, 
of Philadelphia, and other visiting members, were made 
corresponding members for the day. 

Dr. R. B. Fitz Randolph, of Trenton, presented a 
report on the ** Progress in Bacteriology."* 

On motion of Dr. McAlister, the report was accepted 
and ordered printed in the Transactions. 

On motion, the discussion of Dr. Marvel's paper on 
dysentery was taken up. 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 67 

Dr. L. M. Halsey, of WilHamstown, presented the 
report of the Committee on Legislation.* 

The Secretary : I have received from some of the 
county secretaries a statement as to the number of prac- 
titioners in their counties not enrolled in their list, and 
also of the number of irregular practitioners. Fourteen 
out of the twenty counties replied. According to 
their reports, the number of homeopathic practitioners 
was five less than that of the number of the regular prac- 
titioners not members of the county societies. These 
reports are evidently not accurate. County secretaries 
are requested to furnish the State Secretary every year 
with the names and addresses of homeopaths, eclectics 
and osteopaths, as well as those of regular physicians 
not members of the Society. 

On motion of Dr. R. C. Newton, the report of the 
Committee on' Legislation was accepted and its sugges- 
tions ordered carried out. 

Dr. L. M. Halsey introduced for Dr. Kipp a resolution 
regarding the prescribing of eye-glasses,* which was 
unanimously adopted. 

. Dr. W. B. Johnson, of Paterson, the Third Vice-Presi- 
dent, presented an essay on **The Organization and 
Operation of Hospitals and Other Charitable Institutions 
in the State of New Jersey."* 

On motion, it was accepted and ordered printed in the 
Transactions. 

Dr. Talbot R. Chambers, of Jersey City, presented a 
report on the " Progress in Ophthalmology."* 

On motion the report was accepted, and the paper was 
referred to the Committee on Education, and Dr. 
Chambers was made a member of that committee. 

Dr. Frank V. Cantwell, of Trenton, presented a paper,. 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



68 MEDICAL SOCIETY OF NEW JERSEY. 

** Operation for Complete Epispadia by Transplantation 
of the Urethra."* 

On motion, it was accepted and referred to the Com- 
mittee on Publication. 

Dr. Alexander McAlister, of Camden, presented a 
paper on *• Infantile Colic."* It was referred to the 
Committee on Publication. The paper was discussed by 
Dr. W. E. Darnall, of Atlantic City, and Dr. John C. 
Johnston, of Blairstown.* 

Dr. J. J. Kinyoun, of Glenolden, Pa., read a paper on 
'* Mosquitoes and Malaria," which he illustrated by 
numerous plates.* 

The paper was discussed by Dr. Judson Daland, of 
Philadelphia, Dr. Evans, Dr. C. P. Noble, of Philadelphia, 
Dr. Treganowan, of South Amboy, Dr. Marcy, Dr. E. B. 
Silvers, of Rahway, Dr. Armstrong, of Rutherford. Dr. 
Kinyoun closed the discussion.* 

On motion of Dr. Armstrong, seconded by Dr. Marcy, 
it was unanimously voted that a committee be appointed, 
consisting of one member from each District Society, to 
take up the study of mosquitoes and malaria and report 
at the next annual meeting. 

On motion, adjourned at i P. M. 



AFTERNOON SESSION. 

The Society reconvened at the call of the President at 
3.20 P. M. 

The President announced the appointment of the 
Committee on Mosquitoes and Malaria, as follows: 

COMMITTEE ON MOSQUITOES AND MALARIA. 
W. B. Stewart, Atlantic; W. A. Davis, Camden ; H. G. Miller, Cum- 
berland ; Alex. Marcy, Jr., Burlington; Charles Teeter, Essex; 

All reports, papers, etc., marked thus {*) will be found in the Appendix. 



MINUTES. 69 

Randolph Marshall, Cape May ; S. E. Armstrong, Bergen, Temporary 
Chairman ; H. B. Diverty, Gloucester ; L. T. Salmon, Hunterdon ; 
John J. Baumann, Hudson; Cornelius Shepherd, Mercer; John 
Taylor, Monmouth ; D. C. English, Middlesex ; B. D, Evans, Morris ; 
Irwin H. Hance, Ocean ; A. F. McBride, Passaic ; B. W. Ferguson, 
Sussex ; J. P. Hecht, Somerset ; Isaac Barker, Warren ; B. V. Hedges, 
Union ; B. A. Waddington, Salem. 

Dr. H. Genet Taylor presented the report* of the 
Committee on Honorary Membership.* The committee 
recommended the election to honorary membership of 
Dr. Wm. K.Van Reypen, U. S. N., Dr. John Allan Wyeth, 
of New York, and Dr. Lawrence F. Flick, of Philadel- 
phia, Pa. 

On motion, the report was received and the Society 
proceeded to the election of these gentlemen. It was 
moved that the Secretary be instructed to cast the ballot 
of the Society, but the President ruled that, according to 
the By-Laws this was not legal. Dr. A. K. Baldwin, of 
Newark, and Dr. W. Blair Stewart, of Atlantic City, 
were appointed tellers. They reported that 48 ballots had 
been cast, 4 being blank. Dr. Van Reypen, Dr. J. A. 
Wyeth and Dr. L. F. Flick, having received a majority 
of two-thirds, were declared elected. 

The resignation of Dr. J. D. McGill, of Jersey City, as 
permanent delegate from Hudson County, was read, and 
on motion of Dr. Chandler, was accepted. 

Dr. J. N. McCormack, of Kentucky, then spoke as 
follows : 

I should like to preface what I am about to say by telling you that 
although I am here as the ofRcial representative of the American 
Medical Association, and at the invitation of your Secretary, I am 
really here purely in an advisory capacity. I am a member of that 
political party which believes in each State managing its own affairs 
in its own way. I say this that my position may not be misunder- 
stood. 



All reports, papers, etc., marked thus (*) will be found in the Appendix. 



70 MEDICAL SOCIETY OF NEW JERSEY. 

I have been informed that there are some members who are not 
thoroughly advised as to the intention of what is known, in the new 
plan of organization, as the Council. It is a very simple matter, and 
the body is an important one in this plan of organization. The inten- 
tion of this scheme is to divide the State which has been reorganized 
into councillor districts convenient of access to those having charge 
of the work of organization in each district. Your county societies 
are now pretty well organized, but yet there are many members of 
the profession who have not yet availed themselves of membership in 
your State, and hence, this system is probably as important to New 
Jersey as to any other State in the Union. Until you have the entire 
number of reputable physicians in the State enrolled in your Society, 
you will not be able to present a solid front in connection with efforts 
to influence legislation, or for any other purpose. In Alabama, where 
practically every physician of the State has been for many years a 
member of the County and State Societies, such an excellent public 
opinion has existed, that no law relating to medicine or to public 
health affairs has ever been presented to the General Assembly that 
has not been matured by the organized medical profession of that 
State. 

It has been proposed to divide your State into five councillor districts. 
After this year, this Council will be elected, but in order to prevent an 
inter-regnum, it is proposed that your President shall name the first 
body of organizers to work for this year alone. It is intended that 
these gentlemen, after conference with the officials of the county 
society of any county, shall visit such county for the purpose of 
assisting them in the work of bringing into the membership those 
who are yet outside. Perhaps in New Jersey you are not troubled 
with local jealousies and dissensions, but they certainly exist in many 
of the other States I have visited, and I have visited nearly every 
State in the Union. These dissensions have kept a very considerable 
number of worthy members outside of the county society. The 
effort of this particular organization, the Council, is to meet that 
emergency and attempt by co-operation with the county societies to 
bring these physicians into the membership. In other States it had 
been found that a physician from an adjoining county or a distant 
county can accomplish this work better than the physicians of the 
same county. 

1 hope I have made this plain to you. These positions are not very 



MINUTES. 71 

desirable except for active and energetic men, because there is much 
responsibility and the amount of work is considerable. The actual 
travelling expenses alone are defrayed by the State Society, and the 
Councillors receive no compensation. This system is no longer an 
experiment, and I believe that in the course of one, two or three years 
we shall be able to bring into the ranks of the organized profession of 
New Jersey every reputable physician who lives within its borders. I 
shall be glad to answer any question that may be asked. 

Dr. Philip Marvel : Following upon what Dr. McCor- 
mack has said, I desire to offer the following resolution, 
prefacing it by saying that in offering this resolution 
there is no intention of disturbing the present relation 
with the County Societies; the proposed plan merely 
embraces a geographical districting for the councillor 
divisions. 

Resolved, That the State be divided into five Councillor Districts as 
follows : 

1st District— The counties of Sussex, Warren, Morris and Essex. 

2d District — The counties of Union, Hudson. Bergen and Passaic. 

3d District — The counties of Mercer, Middlesex, Somerset and 
Hunterdon. 

4th District — The counties of Camden, Burlington, Ocean and 
Monmouth. 

5th District — The counties of Cape May, Cumberland, Atlantic, 
Gloucester and Salem. 

Resolved, That the retiring President, after consultation with the 
President-elect, shall appoint five councillors, one for each of the dis- 
tricts named, to serve for one year and until their successors are 
elected and installed by the House of Delegates in 1904. 

Resolved, That for the ensuing year the President and Secretary be 
authorized to issue charters to component societies applying therefor. 

On motion of Dr. R. C. Newton, of Montclair, these 
resolutions were unanimously adopted. 

Dr. Frank M. Donahue, of New Brunswick, read a 
paper, "Alexander Operation in the Treatment o.f Retro- 
displacements of the Uterus."* 



All reports, papers, etc.. marked thus (*) will be found in the Appendix. 



^2 MEDICAL SOCIETY OF NEW JERSEY. 

On motion, the discussion was postponed until after 
the presentation of the next paper. 

Dr. J. M. Baldy, of Philadelphia, read a paper, •* Retro- 
displacements and Their Treatment."* The papers were 
discussed by Dr. Mortimer Lampson, Jersey City; Dr. 
Emery Marvel, Atlantic City ; Dr. Philander A. Harris, 
Paterson ; Dr. Charles P. Noble, Philadelphia, and Dr. E. 
J. Ill, Newark. Dr. Baldy closed the discussion.* 

On motion of Dr. McAlister, Dr. J. P. Crozer Griffith 
was allowed to read his paper at this time. Dr. Griffith's 
paper was entitled, ** Pneumonia Simulating Appendi- 
citis."* It was discussed by Dr. E. W. Hedges, of Plain- 
field.* 

Dr. L. M. Halsey, Chairman of the Committee on 
Legislation, asked for instruction regarding the recom- 
mendations made by the Society, (i) with regard to Dr. 
Strock's paper, and (2) with regard to fees. 

On motion of Dr. C. Shepherd, it was unanimously 
voted that the request of the Committee to be continued 
be granted. 

Dr. Eliot Gorton, of Fair Oaks, Summit, presented a 
paper, " Some Practical Methods of Hydrotherapy for 
General Practice."* 

Dr. S. Ziegler, of Philadelphia, read a paper, ** Some 
Disorders of the Eye Due to Nasal Infection."* Discussed 
by Dr. W. P. Eagleton, of Newark, and Dr. T. R. Cham- 
bers, of Jersey City,* 

Dr. C. J. Kipp, of Newark, reported "Two Cases of 
Transient Complete Blindness of Both Eyes."* Discussed 
by Dr. Frank Fisher, of Philadelphia.* 

Dr. T. R. Chambers moved, *' That the Society defray 
the expense of the dinner for those members and guests 
who had not secured accommodation at the Coleman 



All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 73 

House." Seconded by Dr. Taylor. Dr. Chandler said 
that the terms of the resolution were somewhat vague 
and might give rise to discussion ; that he was in favor of 
treating all members alike, whether they were registered 
at the Coleman House or not, but as the hour was late 
and the matter required consideration, he moved that it 
lie on the table until the next morning. Seconded and 
lost. The motion of Dr. Chambers was then unanimously 
carried. 

Dr. C. J. Kipp moved that the Committee of Arrange- 
ments be instructed to carefully note the number of 
members for which the Society is to be charged for 
dinners, and see that only those entitled to such privilege 
shall secure the dinner without cost, as provided for by 
Dr. Chamber's motion. Seconded by Dr. McAlister and 
carried. On motion, adjourned at 6 P. M. 



THIRD DAY— THURSDAY, JUNE 25TH. 

The meeting was called to order by the President at 
9.25 A. M. 

The report of the Fellows* Prize Committee was pre- 
presented by Dr. D. C. English, as follows: 

The Fellows' Committee on Prize Essay report to the Society that 
only one essay has been presented this year on " Vaccination," which 
they have not deemed worthy of an award because of its failure to 
meet the requirements of *' originality in investigation and thought," 
which the Fellows emphasize as essential to a successful competition 
for the prize offered. The committee regrets exceedingly this result, 
because the essay presented is an excellent one, showing that a large 
amount of literary research has marked its preparation. 

Dr. English also reported that — 

The Fellows have chosen as the subject for next year's essays,*' The 
Etiology of Malarial Diseases." The essays should not contain less 



74 MEDICAL SOCIETY OF NEW JERSEY. 

than 2,000 nor more than 4,000 words, and must be characterized by 
originality in investigation and thought, and by clearness and concise- 
ness of expression, and be, in the judgment of the committee, of 
decided value to the members of the Society and the profession gen- 
erally. To the first in order of merit will be awarded the prize of one 
hundred dollars ; to the second, that of honorary mention. Further 
particulars concerning the essays will be published in the Transac- 
tions and also sent to the County Societies by the Committee on Prize 
Essay appointed by the Fellows, Drs. E. L. Godfrey, D. C. English, 
William Elmer. 

On motion of Dr. Chandler, the report was received. 
On motion of Dr. C. J. Kipp, the following resolution 
was adopted : 

Resolved, That the committee having charge of the programme for 
future meetings be directed to give precedence to the papers offered 
by members of this Society. 

On motion of Dr. W. J. Chandler, the following pre- 
amble and resolution urging the national incorporation 
of the American Medical Association was adopted : 

Whereas, It is the belief of the Medical Society of New Jersey 
that reincorporation of the American Medical Association under a 
national charter would elevate the position and increase the dignity of 
the medical profession of this country, therefore, be it 

Resolved, That the American Medical Association be requested to 
make application through its committee to Congress at its next ses- 
sion for a special charter permitting the Association to hold property 
and to meet anywhere within the territorial limits of the United 
States. And be it further 

Resolved, That members of the House of Delegates of the 
American Medical Association- representing this Society are hereby 
instructed to favor and to vote for such national incorporation for the 
American Medical Association, and the Secretary is hereby instructed 
to forward copies of these resolutions to the President and Secretary 
of the American Medical Association, and to the Chairman of the 
Committee on National Incorporation of the American Medical 
Association. 

The Secretary stated that the following nominees for 



MINUTES. 75 

Permanent Delegates having presented their certificates 
were eligible for election : 

Dr. R. H. Parsons and Dr. Enoch Hollingshead, of 
Burlington County ; Dr. David Stephens, of Middlesex 
County ; Dr. George H. Franklin, of Mercer County, and 
Dr. William S. Jones, or Camden County. 

Drs. Reading and English were appointed tellers. 
They reported that 23 ballots had been cast, and that all 
of the candidates had been unanimously elected. 

On motion of Dr. W. J. Chandler, the names of Joseph 
E. Hurff, of Camden, Dr. W. K. Newton, of Paterson, 
and Dr. E. E. De Groft, of Woodstown and Daniel 
Garrison, of Pennsgrove, as nominees for Permanent 
Delegates, were laid over until the next meeting. 

The Secretary read a communication from the Atlantic 
City Board of Trade inviting the Society to meet in that 
city. On motion, the communication was received and 
the Secretary was instructed to answer the communica- 
tion after the report of the Nominating Committee had 
been received and acted on. 

Dr. N. L. Wilson, of Elizabeth, read a paper on "Acute 
Inflammation of the Accessory Sinuses of the Nose."* 

It was discussed by Dr. T. W. Corwin, of Newark, and 
Dr. George E. Reading, of Woodbury. 

Dr. Edward J. Ill, of Newark, presented "A Clinical 
Contribution to the Knowledge of Tuberculous Disease 
of the Female Urinary Tract."* It was discussed by 
Dr. Horace G. Norton, of Trenton, and Dr. Philip Marvel, 
of Atlantic City. Dr. Ill closed the discussion.* 

On motion, it was ordered that the paper* of Dr. E. A. 
Y. Schellinger, of Camden, on ** Advisibility of Surgical 
Interference in Abdominal Contusions," be read by title, 
and that Dr. B. D. Evans' paper be read at this time. 

All reports, papers, etc., marked thus (") will be found in the 'Appendix. 



76 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. B. D. Evans, of Morris Plains, read a paper, 
** Court Testimony of Medical Experts in Mental Dis- 
eases/'* 

These papers were referred to the Committee on Publi- 
cation under the rules. 

Dr. Emery Marvel, of Atlantic City, presented a paper, 
" Unusual Malformations in the Female Generative 
Organs,*** together with specimens. It was discussed by 
Dr. E. J. Ill and Philip Marvel * 

Dr. John C. McCoy, of Paterson, read a paper, ** Ex- 
tensive Fracture of the Skull."* 

On motion. Dr. David C. English was given an oppor- 
tunity to introduce miscellaneous business. He then 
introduced the following resolution : 

Whereas, The new Constitution and By-Laws go into effect on 
the adjournment of this annual session of the Society, and said 
instruments require the appointment of various committees, which 
are essential to the proper working of the Society ; therefore, 

Resolved, That the in-coming President be authorized and empow- 
ered to appoint the committees specified in Chapter IX of the new 
By-Laws at his earliest convenience, and furnish the names of the 
members appointed by him to serve on these various committees to 
the Committee on Publication, to be published in the Transactions.! 

Dr. peorge E. Reading: I move the adoption of this 
resolution. 

All reports, papers, etc., marked thus (*) will be found in the Appendix, 
t The President subsequently appointed the following committees : 

Committee on Credentials — B. W. Hedges, Plainfield; Archibald Mercer, 
Newark; Alexander Marcy, Jr., Riverton. 

Committee on Business — Stephen Pierson, Morristown ; J. P. Hecht, Somer- 
ville ; P. A. Harris, Paterson ; D. M. Skinner, Belleville ; J. A. Exton. Arlington. 

Committee on Honorary Membership — E. J. Marsh, Paterson ; L. M. Halsey, 
Williamstown ; H. Genet Taylor. Camden. 

Committee on Publication—'^. J. Chandler, South Orange ; D. C. English, 
New Brunswick; H. W. Elmer Bridgeton. 

Committee on Scientific Work—T. R. Chambers, Jersey City ; R. H. Parsons, 
Mount Holly ; N. L. Wilson, Elizabeth. 

Committee on Propram—W. J. Chandler, South Orange ; Alexander McAlister, 
Camden ; W. K. Newton. Paterson. 

Committee on Public Hygiene and Legislation— Charles Young, Chairman, 
Newark ; Joseph Tomlinson, Bridgeton; B. A. Waddington, Salem; M. S. 
Ayres, Fair View; Wm. Elmer, Trenton ; C. J. Kipp, Newark. 



MINUTES. JJ 

Dr. Philip Marvel: The By-Laws provide for this. 

Dr. English: They do not; they say the President 
shall provide for vacancies occurring through death or 
removal from the district. 

Dr. Marvel : Section 3, Article IX, says that vacancies 
occurring through death, resignation and otherwise are 
to be filled by the President. 

Secretary : This motion of Dr. English is not in con- 
flict with the intent and provisions of the By-Laws, but 
is merely to insure to the in-coming President the 
authority to make these appointments ad interim. 

Dr. Reading: These vacancies do not occur in the 
interim of the meetings, as the By-Laws provide for. 

Dr. English : I see no objection to the adoption of 
the resolution, because if a question arises this resolu- 
tion disposes of it. 

Dr. Paul M. Mecray, Camden : There must be a 
misunderstanding, .for Dr. Philip Marvel's resolution, 
adopted yesterday, covers this ground. 

The Secretary: Dr. Marvel's resolution had reference 
to the appointment of five Councillors. 

The question being called for, the resolution was unan- 
imously adopted. 

On motion. Dr. E. Field's paper,* on " Exsection of the 
Scapula. — Statistics. — Report of Two Cases," in the ab- 
sence of the author, was read by title. 

The next order was the discussion of the question pro- 
posed by the Business Committee, viz,: "Vaccination. 
How long does it protect, and how shall it be controlled ? 
What are its sanitary and commercial aspects?" 

Dr. George E. Reading, of Woodbury, opened this 
discussion. Dr. W. U. Selover,* of Rahway, followed. 



All reports, papers, etc., marked thus (*) will be found in the Appendix. 



78 MEDICAL SOCIETY OF NEW JERSEY. 

The paper presented by Dr. Selover was referred to 
the Publication Committee under the rules. 

Dr. D. T. Bowden, of Paterson, read a paper, **Some 
Common Deformities and Their Prevention.*** 

The paper was referred to the Publication Committee 
under the rules. 

Dr. Paul M. Mecray, Chairman of the Nominating 
Committee, presented the report of this committee 
as follows : 

For President — Henry Mitchell, Asbury Park. 

First Vice-President— K, W. Taylor. Beverly. 

Second Vice-President — Walter B. Johnson, Paterson. 

Third Vice-President— ^exwy W. Elmer, Bridgeton. 

Corresponding Secretary — E. W. Hedges. 

Recording Secretary — William J. Chandler. 

Treasurer — Archibald Mercer. 

Standing Committee — Y or unexpired term of Dr. Henry W. Elmer. 
Alexander Marcy. Jr., Riverton. For full term, G. H. Balleray, 
Paterson ; W. H. Ireland. Camden. 

Business Committee — Alexander McAllister, Chairman, Camden ; 
B. C. Pennington, Atlantic City ; E. HoUingshead, Pemberton ; Joseph 
M. Rector, Jersey City; Geo. H. Franklin, Hightstown. 

Committee on Honorary Membership — H. Genet Taylor, Camden ; 
Alexander W. Rogers, Paterson ; Charles J. Kipp, Newark. 

Committee of Arrangements— Th^o, Senseman, Chairman, Atlan- 
tic City ; Walter Reynolds. Atlantic City ; W. B. Stewart. Atlantic 
City ; W. E. Darnall, Atlantic City ; Paul M. Mecray. Camden ; Geo. 
E. Reading, Woodbury ; Geo, F. Wilbur, Asbury Park. 

Delegates to American Medical Association — Chairles J. Kipp, 
E. J. Marsh. 

Alternate— Vim, F. Faison. 

Delegates to New York AJedical Society — E. B. Silvers, Rahway ; 
D. A. Currie, Englewood ; W. J. Chandler, South Orange. 

Delegate to New Hampshire Medical Society — Edwin Field, Red 
Bank ; J. G. Ryerson, Boonton ; S. O. B. Taylor, Millstone. 

Delegates to Connecticut Medical Society — J. A. Exton, Arlington ; 
S. A. Heifer, Hoboken. 



All reports, papers, etc., marked thus (") will be found in the Appendix. 



MINUTES. 79 

Delegates to Rhode Island Medical Society — A. J. Alexander, 
Paterson ; M. S. Ayres, Fairview. 

Delegates to Maryland Medical Society — R. M. Curts, Paterson; 
W. H. Iszard, Camden ; B. D. Evans, Morris Plains. 

Delegates to Delaware Medical Society — Charles S. Heritage. 
Glassboro ; E. E. DeGrofft, Woodstown ; William A. Davis, Camden. 

Delegates to Mississippi Valley Medical Association — Wm. F. 
Faison, Jersey City ; J. T. Gilson, Paterson ; Geo. E. Reading, 
Woodbury. 

Delegates to Massachusetts Medical Society — J. A. Exton, Arling- 
ton ; S. A. Heifer. Hoboken ; F. H. Todd. Paterson ; W. R. Kinmouth, 
Farmingdale. 

Delegates to the American Pharmaceutical Association — H. L. 
Coit, Newark ; Dr. E. B. Silvers. Rah way. 

Delegates to the Pennsylvania Medical Society — Wm. S. Jones, 
Camden ; H. H. Lucas, Paterson ; H. H. Wilson, Woodbury ; Cor- 
nelius Shepherd, Trenton ; Daniel Stout, Berlin ; J. F. Leavitt, 
Camden. 

Delegate to the North Carolina Medical Society — Dr. Wm. F. 
Faison, Jersey City. 

Atlantic City selected as the place of meeting 1904. Date : Day 
preceding meeting American Medical Association. 

Paul M. Mecray, 

Chairman Nominating Committee, 
H. H. Brinkerhoff, 

Secretary, 

Dr. W. B. Johnson, of Paterson, moved that the report 
of the Nominating Committee, except in so far as the date 
of holding the meeting, be approved. Seconded by Dr. 
McAlister and carried. 

Dr. Philip Marvel : I move that the Society meet in 
Atlantic City on Friday, Saturday and Monday, June 3, 
4 and 6, 1904. The motion was not seconded, and he 
subsequently changed it to meet in Atlantic City on June 
21, 22 and 23, 1904. Seconded by Dr. C. Shepherd. 

Dr. Barker offered as an amendment that the Society 
meet in Asbury Park. Amendment lost. Original 
motion carried. 



8o MEDICAL SOCIETY OF NEW JERSEY. 

On motion, the Secretary was instructed to cast a ballot 
for the names presented by the Nominating Committee. 
The ballot was cast, and they were declared unanimously 
elected. 

Dr. W. B. Johnson : I move that the report of the 
Nominating Committee with regard to the Committee 
on Arrangements be approved. Seconded and carried. 

On motion of Dr. Chandler, it was voted that the names 
of Dr. Clark and Dr. Bruyere, as nominees for Permanent 
Delegates from Mercer County, lie over for one year. 

Dr. W. J. Chandler : I move that the custody of the 
Transactions of the Society, now in the State Library 
at Trenton, be given to the William Pierson Library 
Association until otherwise provided for. Seconded by 
Dr. W. B. Johnson and carried. 

On motion, the execution of the provisions of the last 
motion was referred to the Committee on Publication. 

The President announced the appointment of the 
Councillors as follows : 

First Z?/j/r/V/— Thomas W. Harvey, of Orange. 
Second District—], L. Leal, of Paterson. 
7'A/rdfZ?M/r/V'/— Cornelius Shepherd, of Trenton. 
Fourth District — Daniel Strock, of Camden. 
Fifth Z>w/r/V/- Philip Marvel, of Atlantic City. 

On motion, the Society finally adjourned at 12.30 P. M. 



APPENDIX TO THE MINUTES. 



Treasurer's Report. 

Dr. Archibald Mercer, Treasurer, in account with the Medical 
Society of New Jersey. 1902- 1903. 

Dr, 
June, 1902. Salem County, Additional Payment 

for 1902 $1 00 

" Morris County, Additional Payment 

for 1902 500 

July, 1902. Essex County, Additional Payment 

for 1902 I 00 

Middlesex County. Additional Pay- 

for 1902 200 

Dr. A. Fischer, Fee for Diploma. . . 15 00 

June, 1903. Atlantic Co., Assessment for 1903. . 47 00 

Bergen Co., •• '* . . 38 00 

Burlington Co., ** •* . . 33 00 

Camden Co., ** ** . . 76 00 

Cape May Co., " •' . . 19 00 

Cumberland Co., *' '* . . 37 00 

Essex Co.. *• •• . . 237 00 

Gloucester Co., " " . . 28 00 

Hudson Co., " " . . 148 00 

Hunterdon Co., " ** . . 24 00 

Mercer Co.. " *' . . 65 00 

Middlesex Co., " ** . . 34 00 

Monmouth Co., " ** . . 46 00 

Morris Co., *• '* . . 58 00 

Passaic Co., " " .. 81 00 

Salem Co., *• " .. 18 00 

Somerset Co., '• ** . . 25 co 

Sussex Co., •• '• . . 20 00 

Union Co., " *' . . 69 00 

Warren Co., " " .. 21 00 



Interest on U. S. Bonds 

To Cash Balance in Bank. June, 1902. 
" U. S. Registered 4^ Bonds 



$1,148 00 
102 00 

2,553 03 
2.550 00 

$6,353 03 



82 MEDICAL SOCIETY OF NEW JERSEY. 

Cr. 

June, 1902. Dr. William J. Chandler, Rec. Sec'y $65 52 
Dr. H. W. Elmer. Chairman Stand- 
ing Committee 1675 

** Dr. E. W. Hedges, Cor. Secretary. 14 50 
" Dr. Archibald Mercer. Treasurer.. 17 36 
" Dr. G. E. Reading. National Legis- 
lation Committee 10 85 

Dr. H. W. Elmer. Tuberculosis 

Sanatorium Committee I2r 65 

" Dr. L. M. Halsey, Legislation Com. i 00 
Dr. H. W. Elmer, Tuberculosis San- 
atorium Committee 15 00 

The Whitehead & Hoag Co 40 00 

" Orange Chronicle Co 43 80 

July, 1902. Dr. O. C. Ludlow, Stenographer... 65 00 
Dr. H. W. Elmer, Tuberculosis 

Sanatorium Committee 535 

Orange Chronicle Co 29 25 

Sept., 1902. L. J. Hardham, on acct. of Transac- 
tions 350 00 

Oct., 1902. Dr. W.J. Chandler, Rec. Secretary 159 00 

L.J. Hardham, Printing 1075 

** 1-. J. Hardham, Balance for Tran- 
sactions 454 00 

Dec, 1902. Dr. P. Marvel, Chairman Committee 
on Revision of Constitution and 

By-Laws 98 70 

Mch., 1903. Dr. W. J. Chandler, Rec. Secretary 60 00 

$1,578 48 

June, 1903. By Balance in Bank, June 20, 1903.. 2.224 55 

" U. S. Registered 4^ Bonds 2.550 00 



$6,353 03 



Report of the Recording Secretary. 

To those of you who have cherished the interests and watched the 
growth of this Society for many years, it will be a source of gratifica- 
tion to know that we have now on the rolls of our County Societies a 
total of 1,122 names. Last year we had 1,061, thus showing a net 
increase of 61. Four counties come to us with a smaller number 



REPORT OF THE RECORDING SECRETARY. 83 

than that of last year — a total loss of 9. One county reports the same 
number, and fifteen counties show gains of from one to twelve each — 
a total gain of 70. The largest gain and the largest percentage of 
gain was made in Camden County, which now has a membership of 75. 

From the reports of some of the counties, it is evident that many 
regular physicians are settled and* practicing in our midst who are not 
(and some never have been) members of any District Medical Society. 
Whose fault is this ? If they are reputable physicians, they ought to 
be invited to join the only recognized medical organization of this 
Society in their county. If the County Society does not offer induce- 
ments enough to stimulate every medical man therein to desire to be- 
come a member, then that County Society is not doing its bounden 
duty. It is slothful, or it is stupidly dull. It does not realize the 
duties and the dangers of the hour. The hosts of quackery in pro- 
tean forms are ever on the alert and are stealing advantages at every 
opportunity. These opportunities arise too often from professional 
jealousies and the want of organized effort. Nothing will so efficiently 
overcome the one and make potent the other as an active, genial, 
competent and scientifically working County Society. See to it, then, 
that next year there is not a regular physician of good standing in 
your county who has not been invited, urged — yes, persuaded, to be- 
come a sharer with you in the benefits of the District Medical Society. 

We began this year with the names of 117 Permanent Delegates 
on our lists. Two have died — Dr. Theodore H. Boyeson, of Egg 
Harbor City, Atlantic County, and Dr. Arthur Ward, of Newark, 
Essex County — leaving us at the present time a total membership of 
1 1 5. There were dropped for absences at the last annual meeting five 
names. This being the appointed year for the triennial selection of 
nominees for Permanent Delegates, there have been selected as such 
nominees and to fill the vacancies occasioned by death and delinquen- 
cies, 31 candidates from 14 counties. Six counties make no nomina- 
tions. The list of these nominees is as follows : 

NOMINEES FOR PERMANENT DELEGATES. 

Atlantic Count^—E. A. Reilly, Atlantic City ; W. E. Darnall, 
Atlantic City ; J. A. joy, Atlantic City (to fill vacancy). 

Burlington County — Enoch Hollingshead, Pemberton. 

Camden County - Alexander McAlister, Camden (to fill vacancy) ; 
Joseph E. Hurff, Blackwood ; William S. Jones, Camden ; Harry H. 
Sherk, Camden. 



84 MEDICAL SOCIETY OF NEW JERSEY. 

Cape May Cit7i#ff/>'— Randolph Marshall, Tuckahoe. 

Cumberland County—^^ . L. Newell. Millville ; J. C. Applegaie. 
Bridgeton. 

Essex Ct?««(y— Henry L. Coit, Newark; Theodore W. Con^in, 
Newark ; John H. Bradshaw, Orange ; David £. English, Milbum ; 
Richard G. P. Dieffenbach, Newark ; George B. Philhower, Nutley ; 
Edward Staehlin, Newark ; Livingston S. Hinckley, Newark ; Richard 
P. Francis, Montclair. 

Gloucester County — Eugene Oliphant, Bridgeport. 

Middlesex 0««/>'— David Stephens, New Brunswick. 

Morris County — A. A. Lewis, Morristown. 

Passaic County — Wm. K. Newton, Paterson. 

Salem County— Y., E. DeGrofft, Woodstown (to fill vacancy) ; 
Daniel Garrison, Pennsgrove. 

Sussex County — H. D. Van Gaasbeck, Sussex (to fill vacancy) ; 
E. Morrison, Newton. 

Union County— T. N. McLean. Elizabeth. 

Warren County— G. W. Cummins, Belvidere. 

Bergen, Hudson, Hunterdon, Monmouth and Somerset make no 
nominations. 

Mercer makes no report. 

Two Permanent Delegates — Dr. Alexander Marcy, of River ton. 
Camden County, and Dr. A. W. Taylor, of Beverly. Burlington 
County — present their resignations to the Society at this meeting. 

The following have been absent from two successive annual meet- 
ings : David St. John, Hackensack. Bergen County ; N. Newlin 
Stokes. Moorestown, Burlington County ; L. E. Hollister, Newark, 
Essex County; M. A. Mackintosh, Paterson, Passaic County; E. 
Morrison, Newton, Sussex County; Alva C. Van S>ckle, Hacketis- 
town, Warren County. 

The excuses of Drs. St. John, Hollister and Mackintosh were 
accepted and their names are retained. 

The excuses of Drs. Stokes, Morrison and Van Syckle were not 
satisfactory and their names are dropped from the roll. The vacan- 
cies thus created can be filled after the Secretaries of the respective 
County Societies have received official notification from the Recording 
Secretary of the Medical Society of New Jersey. 

The question is often asked, " How many attend the meetings of 
our Society ? " There were present last year, according to the Regis- 



REPORT OF THE RECORDING SECRETARY. 85 

tration Book, 219 members, as follows: Fellows, 11 ; Officers and 
Standing Committee, 12; Permanent Delegates, 72; Annual Dele- 
gates and Corresponding Members, 124. 

It is a great pleasure to be privileged to announce to you that we 
have with us to-day representatives of every one of the twenty-one 
counties of this State. We welcome here to-day for the first time in 
many years representatives from Ocean County. This District Society 
has been for a long period in a state of suspended animation. It is 
now aroused, and taken hold of by men who wish to make it a live 
Society, and who will enter into their work with ability and determi- 
nation. Let us hope that their efforts will be pre-eminently successful, 
and that they will send to us every year an influential and progressive 
delegation. 

Among the many important subjects to be presented to your con- 
sideration at this meeting there is none of more importance than the 
revision of the By-Laws. Our present By-Laws have been several 
times amended ; resolutions have been passed from time to time. 
Some have been repealed and some are still in force, so that it is im- 
possible for any one not thoroughly conversant with the proceedings 
of the Society for the past ten years to make a positive ruling on a 
disputed point. Some revision and codification of these laws is, 
therefore, necessary. The American Medical Association has adopted 
a new constitution and by-laws, involving many changes in its methods, 
and has suggested a plan of organization which it wishes the State 
societies to adopt, with such modification as may seem to each one to 
be necessary. It is certainly desirable for us to adopt rules in har- 
mony with these general principles, and to make such other changes 
in our present laws as may be consistent with the desires of the 
American Medical Association and compatible with our venerable 
traditions. In such matters it is well to make haste slowly. We 
have, therefore, held the report of the Revision Committee of last year 
over until this year. We have sent a copy of the proposed new By- 
Laws to every member of every County Society in the State, in the 
hope that the matter might be thoroughly and calmly considered, 
and a decision on the various changes obtained without unnecessary 
delay. Some alterations should be made at this session; as, for 
instance, to make every member of a County Society in some way also 
a member of the State Society. Otherwise we shall be compelled to 
reduce our representation in the American Medical Association from 
three delegates to one. 



86 MEDICAL SOCIETY OF NEW JERSEY. . 

The time of holding the annual meetings of the various County 
Societies varies very greatly. One holds its meeting in January ; one in 
February ; eight hold theirs in April ; nine have fixed on May, and 
one waits until the first Tuesday in June. This want of uniformity 
may seem at first thought to be a trivial matter. While it may not 
be as objectionable to hold the meetings early in the season, it is quite 
so to hold them late. The County Secretary cannot send in his 
returns until after the annual meeting. These returns pass to your 
Recording Secretary and form the basis of the mailing list, furnish 
data for the programme, and. after careful comparison and correction, 
are printed in the Transactions. All this consumes much time and 
involves considerable correspondence. The programme ought to be 
ready for the printer by the middle of May, and in order to do this 
the annual meeting should be held not later than the middle of April. 
Many of the County Secretaries are busy medical men, and have not 
always time to immediately revise and forward the returns. And in 
some instances it seems that the pressure of other cares is great 
enough to entirely crowd this matter out of their minds, and their 
returns come in just too late to admit of publication in the programme. 
I call attention to this subject at this time for the reason that if 
changes are made in the By-Laws of this Society it may involve the 
changing of by-laws in several of the County Societies, and at that 
time the advisability of holdmg the annual meetings earlier could be 
considered. 

The equipment of the Secretary's office has been rendered quite 
complete by the purchase of a typewriter, a duplicator and a letter 
press. These instruments lighten the labor and perfect the work of 
the office. It is now possible to transact with greater promptness the 
business of the Society, and to preserve exact and legible copies of all 
communications sent out. 

I cannot close this report without acknowledging my indebtedness 
to the County Secretaries and to the other members of this Society for 
their valuable assistance in answering the various inquiries made of 
them during the past year. This is a great help to your Secretary, 
the success of whose labors is so largely dependent on their aid. 

It is a matter for congratulation that for so many years this spirit 
of helpfulness and good will has prevailed so generally throughout 
our Society. Our meetings are especially characterized by sociability 
and friendliness. They are looked forward to by some as the occa- 



REPORT OF THE CORRESPONDING SECRETARY. 87 

sion of the season. To those of us who have met thus for so many 
successive years* they stand as milestones along the pathway of our 
medical lives. Each one as it recurs brings us nearer to a complete 
understanding of one another, strengthens the ties of personal friend- 
ship, and begets a love for our professional brethren and for that 
humanity which we serve akin to that of the Great Physician. 

Respectfully submitted, 

Wm. J. Chandler, Rec. Sec'y, 



REPORT OF THE CORRESPONDING SECRETARY. 

June 23, 1903. 
To the Medical Society of New Jersey : 

The Corresponding Secretary respectfully reports that he has 
attended to the duties devolving upon him during the past year. 

Copies of our Transactions have been sent to all of the State soci- 
eties, to many of the national societies, to some foreign societies and 
to many public libraries. In return, we have received Transactions 
from the following State societies : West Virginia, Massachusetts, 
Mississippi, Missouri, Maryland, Wisconsin, Indiana, Tennessee, 
New Hampshire, Arkansas, Alabama, Connecticut, Nebraska, Ver- 
mont, Texas and New York. 

The Recording Secretary, Dr. Chandler, has on hand about one 
thousand volumes of the Transactions of different years in the past. 
Copies of these are frequently asked for by public libraries and by 
individuals to add to a library or to complete a set. There are no 
complete sets in this collection. If any members of the Society have 
back numbers which are of no use to them, they could, by sending 
them to Dr. Chandler, add to this stock and put their books where 
they might be of great service. 

Pursuant to the By-Laws, your Secretary notified the county soci- 
eties of Hunterdon, Mercer, Middlesex, Monmouth and Morris of 
their privilege of each selecting a member to read a paper at this 
meeting of the State Society, and all but one are represented on our 

programme. 

Ellis W. Hedges, 

Corresponding Secretary. 



88 medical society of new jersey. 

Report of the Committee of Arrangements. 

To the Medical Society of New Jersey : 

As this is the seventh time the Society has met in Asbury Park or 
vicinity, I shall not call your attention to the advantages of Asbury 
Park as a convention city. Your committee chose the Coleman 
House as the place of meeting, and through the courtesy of the man- 
agement of the hotel, places at your disposal the ball room, com- 
mittee rooms and the rooms occupied by the exhibitors. A general 
rate was secured of three dollars per day, rooms with bath four dol- 
lars. In accordance with a motion passed last year, your committee 
has made every effort to secure suitable badges at the price specified. 
We have been in communication with different firms supplying these 
badges, and failed to secure suitable badges at the price specified. 
After exhausting every means to comply with this motion, a contract 
was closed with the Whitehead & Hoag Company to supply 250 in 
bronze and 1 50 in oxidized silver for fifty-five dollars. There have 
been forty-seven spaces taken by the exhibitors. This is very much 
in excess of any previous exhibit. The price per space was fixed at 
five dollars, placing $235 in the hands of the committee to defray its 
expenses. A new feature introduced this year was the sending of a 
formal invitation to each member and a number of the local residents, 
calling their attention to the social functions occurring during the 
meeting. The annual dinner will take place Wednesday evening, 
June 24th, at seven o'clock. This will not be the regular dinner, but 
one specially prepared for the members of the Society and their guests. 
To members registering at this hotel there will be no extra charge for 
the dinner, but other members will register at the office and pay the 
usual charge for dinner. 

During the evening D. M. Skinner, M. D., will respond to " Our 
Society;" D. C. English, M. D.. "Our Fellows;" W. B. Johnson. 
M. D., "Our Vice-Presidents;" T. R. Chambers, M. D.. "Our 
Specialties;" Cyrus F. Brackett, M. D., LL. D., "Our Honorary 
Members ; " and the Hon. George Wurts, " The Physician as a Citi- 
zen." After the dinner a reception will be given in this room. Mem- 
bers are requested to wear the buttons which have been distributed, 
that they may be recognized and admitted. The expenditures of the 
committee will be less than the amount received from the exhibitors, 
but at this time it is impossible to give a detailed report, which will 
be forwarded at a later date. 

Respectfully submitted, 

John Taylor. M. D., 
Chairman Committee of Arrangements. 



report of the committee on business. 89 
Report of the Committee on Business. 

Mr. President and Members of the Medical Society of New fersey : 

The Committee on Business present the printed program for order 
of exercise of this, the one hundred and thirty-seventh annual meet- 
ing of the Society. 

The Wednesday evening literary session will be omitted, the Com- 
mittee of Arrangements having provided social enjoyment for that 
occasion. The Business Committee would suggest that in the future 
more entertainment be provided for the ladies ; this will ensure a 
larger attendance of Doctors than in the past. 

The Business Committee would recommend that the time limit be 
rigidly enforced in the discussion and reading of papers, and for all 
matters of business. Questions incident to the progress of the meet- 
ing should not exceed the same, as the program is a lengthy one. The 
following paper came in too late to be placed on the program : 

" Deformity and Its Prevention." Dr. D. T. Bowden, Paterson, N. J. 

The committee would request that members connected with hospi- 
tals and institutions throughout the State would present pathological 
specimens, new instruments and apparatus ; the members in the past 
having given this very little attention. This recommendation, if car- 
ried out. would add much scientific interest to the sessions. For this 
meeting the committee have selected two or more members to open 
the discussion on each paper, which we earnestly hope will promote a 
more general discussion of each subject. This feature of the program 
we would recommend for future meetings ; also, that members pre- 
senting papers in the future select members to open the discussion on 
said papers. This would aid the Business Committee very materially 
in arranging the program. 

The question selected by the Business Committee last year for dis- 
cussion at this meeting is a practical one : " Vaccination. How Long 
Does It Protect ? How Shall It Be Controlled ? What Are Its San- 
itary and Commercial Aspects?" We hope there will be a general 
discussion. 

Regarding a subject for discussion next year, the Business Com- 
mittee recommend that it be not selected before March, 1904. 

The Business Committee desire to thank the members who have so 
kindly consented to contribute papers at this meeting, and we would 
urge each individual member to do more scientific work, so that at 



90 MEDICAL SOCIETY OF NEW JERSEY. 

future meetings we may have a more liberal response in the presenta- 
tion of voluntary contributions, reports of interesting cases, prepara- 
tion of pathological specimens or exhibitions of new instruments and 
apparatus, and thus more fully meet the scientific requirements of the 
Medical Society of New Jersey. 

Respectfully submitted, 

Alexander Mc A lister. Chairman, 

G. H. Franklin, 

B. C. Pennington, 

£. HOLLINGSHEAD. 

June 23, 1903. 



Report of Committee on Honorary Membership. 

To the Medical Society of New Jersey : 

The Committee on Honorary Membership would respectfully report 
that the names of Dr. William K. Van Reypen, U. S. N., of New 
Jersey, Dr. John A. Wyeth, of New York, and Dr. Lawrence N. 
Flick, of Pennsylvania, were proposed at the last Annual Meeting of 
the Society for Honorary Membership and referred to this committee. 

Rear Admiral William K. Van Reypen, M. D.. U. S. N. 

Dr. William Knickerbocker Van Reypen was born at Bergen, New 
Jersey, November 14th, 1840. He attended public and private schools 
in Bergen, and at the age of fourteen entered the Sophomore class at 
the University of New York, from which institution he graduated in 
1858. Soon after graduation he commenced the study of medicine 
at the University Medical College of New York and became a pri- 
vate student of Dr. Alfred C. Post, the then Professor of Surgery ai 
the College. In his second year he received the prize for anatomical 
dissection and for the best clinical record. He was also appointed 
Junior Interne at the New York Hospital. In April, 1861, while yet a 
medical student, he was appointed Assistant Surgeon of the 2d New 
Jersey Militia, and served with that Regiment during the War of the 
Rebellion until it was mustered out in August, 1861. In December, 
1 86 1, before graduation, he entered the Navy as Assistant Surgeon in 
the regular service. He graduated in Medicine in 1862, and in 1864 
received the degree of A. M. from the New York University. In 
March, 1862, he was assigned to duty at the Naval Hospital, New 



COMMITTEE ON HONORARY MEMBERSHIP. 9I 

York, where he remained until September of that year, when he 
was ordered to Key West in charge of the Marine Hospital at that 
place. The Hospital was then being used by the Navy as a Yellow 
Fever Hospital ; at the time of his arrival, there were fifty-six cases 
of Yellow Fever in the Hospital ; the medical officer in charge having 
just died. In ten days he was attacked by the fever, from which he 
had a slow recovery. He remained on duty at the Hospital until 
December. 1 864, passing through another severe epidemic of Yellow 
Fever during the latter year. He wgis promoted to Past Assistant 
Surgeon in 1865 ; to Surgeon in 1868 ; to Medical Inspector in 1887 ; 
to Medical Director in 1 895, and was appointed Surgeon General of 
the Navy in October, 1897. being reappointed in 1901, and voluntarily 
retired after more than forty years' service with the rank of Senior 
Rear Admiral, on January 25th, 1902. 

During his naval career he was Fleet Surgeon of the Pacific-North 
Atlantic and Squadron of Naval Review ; served nearly nine years as 
Assistant to the Bureau of Medicine and Surgery, and was on duty at 
many of the Naval Hospitals. He was sent by the Department as a 
Delegate to the International Medical Congress at Moscow in 1897, 
and read a paper on •• The Care of Wounded in Naval Engagements," 
presenting a plan of an ambulance ship that he had devised. Soon 
after his appointment as Surgeon General, War with Spain com- 
menced, and he designed and fitted out the ambulance ship '• Solace," 
which vessel was the first of her kind of any nation. Her service dur- 
ing the Spanish War has become historical. Following his retirement 
he was appointed by the Department of State a delegate to represent 
the Government at the Red Cross Conference in St. Petersburg in 
May, 1902. 

He is a member of the Holland Society of New York : Ex-Senior 
Vice Commander of the District of Columbia Commandery, Military 
Order of the Loyal Legion of the United Stales ; a member of the 
Sons of the American Revolution ; the Geographical Society ; the 
University Club of New York ; the Metropolitan Club of Washington, 
and an honorary life member of the Carlton Club of Brooklyn. 

Professor John A. Wyeth, M. D., LL.D. 

Dr. Wyeth was born in Marshall County, Alabama, on the 26th of 
May, 1845, and is the son of Louis Wyeth, lawyer and judge of one 
of the judicial districts of Alabama. His grandfather was a farmer 



92 MEDICAL SOCIETY OF NEW JERSEY. 

and private in Captain Samuel Thatcher's Company of the Massachu- 
setts Militia, which attacked the British and drove them into Boston 
on the retreat from Lexington on April 19th, 1775. ^^ Paige's history 
of Cambridge it is stated that there were five Wyeths who marched 
to the alarm. The founder of this branch of the fannly in America 
was Nicholas Wyeth, or Wythe, as the name is sometimes spelled in 
the middle of the seventeenth century, with that singular indifference 
of oOr ancestors as to the way in which their names were spelled. 
Dr. Wyeth's mother was Euphemia Allan, the daughter of a Presby- 
terian minister who settled in Tennessee, having emigrated from 
England. He afterwards removed to Huntsville, Alabama. 

Dr. Wyeth was educated first in the common school at Guntersville. 
Alabama, and for a year at the .Military Academy at Lagrange, Ala- 
bama. He served as a private soldier in the Confederate Army, was 
distinguished for gallantry, and was unfortunate enough to be a pris- 
oner of war for a long time, but he has very grateful remembrance of 
one of our profession. Dr. Charles J. Kipp. of Newark, who, while Dr. 
Wyeth was imprisoned in Camp Morton, Indiana, and dangerously ill 
with pneumonia, gave him tender care and consideration, Dr. Kipp 
being the chief physician to the Military Hospital. Dr. Wyeth was 
then only 18 years of age. He was very slight, and he attributes 
some of the tenderness of the Union physician to his apparently help- 
less condition, for he was a very young and a very sick soldier. 

Dr. Wyeth commenced the study of medicine in 1867, and was 
graduated at the University of Louisville in 1869, took the Adeundem 
degree in the Bellevue Hospital Medical College in 1873, in which 
year he was appointed assistant demonstator of anatomy and pro- 
sector to the chair of anatomy in 1874. He was awarded the Alumni 
Association prize in 1876 *' for the best essay on any subject connected 
with surgery or surgical pathology," his subject being *' Amputations 
at the Ankle Joint." Dr. Wyeth also won the first prize of the Amer- 
ican Medical Association in 1878, for an Essay on "The Surgical 
Anatomy and Surgery of the Common, External and Internal Caroted 
Arteries." He was appointed surgeon to Mt. Sinai Hospital in 1880. 

One of Dr. Wyeth's achievements was the establishment of the 
New York Polyclinic, which may be easily said to owe its existence 
and its continuous success as a great school for practitioners of med- 
icine chiefly to his efforts. Although surrounded by many distin- 
guished and excellent teachers, Dr. Wyeth, in executive capacity, is 



COMMITTEE ON HONORARY MEMBERSHIP. 93 

facile princeps, while he is also a surgeon of more than ordinary 
ability. Dr. Wyeth has written as follows : " A Text Book on Sur- 
gery" (1886), '* Bloodless Amputation at the Hip Joint" (1890). 
" Osteo-Plastic Operation for Correction of Deformities of the Nose 
and Palate" 1892; an historical sketch entitled " The Struggle for 
Oregon/' in Harper's Magazine (1892), and a considerable number of 
contributions to various scientific productions. He was twice Presi- 
dent of the New York Pathological Society, and in 1893 First Vice- 
President of the American Medical Association. In 1898 he published 
the " Life of Lieutenant General Nathan B. Forrest," (Harper Bros.) 
In 1900 he was elected President of the New York State' Medical 
Association, and in 1901 was made President of the American Medi- 
cal Association. The same year (1901) he received the Degree of 
Doctor of Laws from the University of his native State, Alabama. 
Dr. Wyeth is also consulting Surgeon to the Long Branch Hospital, 
and lives there four months every year. 

In 1886 he was married to Florence Nightingale Sims, daughter of 
the eminent surgeon, the late J. Marion Sims. 

Lawrence F. Flick. M. D. 

Dr. Flick was born August loth. 1856. in Carroll Township. Cam- 
bria Co., Pa. His father and mother were pioneers of the mountain 
region of Cambria County. He received his preliminary education 
in the township school, with occasionally a few months in a sub- 
scription school. At the age of thirteen he was sent to the Benedic- 
tine College near Latrobe, Pa., where he attended four years and a 
half. He left College before taking his degree because of ill health. 
He graduated in medicine at Jefferson College, Philadelphia, in 1879. 

The titles of papers which he has read and subsequently published 
are: "The Hygiene of Phthisis," 1888; "The Contagiousness of 
Phthisis," 1888; "A Review of the Cases of Tuberculosis which 
Terminated in Death in the Fifth Ward of the City of Philadelphia 
During the Year 1888." 1889; "How to Care for the Lungs," 1889; 
" The Mode of Entrance of the Bacillus Tuberculosis into the Sys- 
tem," 1889 ; " The Treatment of Tuberculosis," 1890 ; " Special Hos- 
pitals for the Treatment of Tuberculosis," 1^90; "The Prevention 
of Tuberculosis, a Century's Experience in Italy Under the Influence 
of the Laws of the Kingdom of Naples Enacted in 1782," 1890; 
"Some New Points in the Treatment of Tuberculosis," 1891'; "A 



94 MEDICAL SOCIETY OF NEW JERSEY. 

Further Report of the Treatment of Tuberculosis by Iodoform Unc- 
tions," 1892 ; " The Influence of the Doctrine of Contagion Upon the 
Death Rate from Tuberculosis in the City of Philadelphia," 1892; 
" Practical Measures in the Prevention of Tuberculosis." 1893 ; " The 
Funeral Director as a Factor in the Prevention of Disease," 1894 ; 
** Prophylaxis in the Treatment of Tuberculosis," 1894; ** The Con- 
trol of Tuberculosis," 1896 ; ** Contagiousness of Tuberculosis," 1897 ; 
•'Consumption, its Nature, History, Cause and Prevention," 1897; 
** Nitro-glycerine as a Hemostatic in Hemoptysis," 1898 ; " Immunity 
the Fundamental Principle Underlying all Treatment of Tubercu- 
losis," 1898; *' The Treatment of Tuberculosis," 1899; "Contagion, 
its Meaning and its Limitations," 1899; "Immunity as Against Her- 
edity in Tuberculosis," 1899; "The Therapeutics of Tuberculosis," 
1900; "Registration of Tuberculosis," 1901 ; "Public Control of 
Tuberculosis," 1901 ; " Home Treatment of Tuberculosis," 1901 ; 
"Primary Abdominal Tuberculosis," 1 901 ; "The Implantation of 
the Tubercle Bacillus." 1902 ; " Differential Diagnosis Between 
Tuberculosis of the Lungs and Diseases which Resemble It," 1903. 

In consideration of the distinguished medical careers during their 
life work in the medical profession, as embraced in this report, your 
Committee take pleasure in recommending Drs. William K. Van 
Reypen. John A. Wyeth and Lawrence F. Flick as Honorary Members 
of this Society. 

H. Genet Taylor. 

Charles J. Kipp. 

ALEX. W. Rogers. 



Report of the Committee on Abuse of Medical 
Charity. 

Your Committee on Abuse of Medical Charity, in lieu of a bill for 
legislative action, begs leave to present conclusions which it has 
arrived at after careful consideration and personal investigations made 
into the management of some of the larger institutions in this country 
and abroad. We are convinced that it would be difficult for us to 
secure satisfactory legislative action on account of the indifference of 
legislators or else their fear of seeming to antagonize the so-called 
" poorer masses." 



COMMITTEE ON ABUSE OF MEDICAL CHARITY. 95 

Supposing that legislation could be brought about» there is proba- 
bility that the matter would drift into the realm of politics and thus in 
a great measure defeat the desired object. One member of your 
committee during the last year visited a large number of European 
Dispensaries and Clinics, and always with the hope of finding some 
practical method employed for the exclusion of unworthy applicants. 
In a few only was there any efficient means used to accomplish this 
object. In London, and notably in the London General Hospital and 
St. Bartholomew's, a form of home visitation has been resorted to 
which has seemed to render fairly good results Practically the same 
plan has been adopted by the Newark Charitable Eye and Ear Infirm- 
ary, in Newark, and in a lesser degree by some of the other institu- 
tions of the State. 

The exclusion of impostors from the free dispensaries and clinics, 
in the opinion of the committee, can, in all probability, best be secured 
by some plan like this. Each large institution, or several smaller ones 
combined, might employ a *' house visitor " to investigate the pecun- 
iary circumstances, as far as possible, of all suspicious applicants, a 
list of such suspects being furnished the visitor by each institution. 
This would presuppose the co-operation of the management of 
these charities. But we must not lose sight of the fact that many 
institutions with dispensaries attached are not anxious for the protec- 
tion we propose to give them, and, in fact, object for obvious reasons. 
They do not view this evil in the same light as th^ medical profession, 
and it may take a long time to educate them up to its full apprecia- 
tion, but it will come before long. Primarily, the members of our 
own profession are to be benefited by remedying the present abuse of 
medical charity. Granting this to be true, why should they not be 
the ones to take the initial step. 

Your committee would respectfully suggest the propriety of the 
State Society recommending to the District Medical Societies, espe- 
cially those embracing the larger cities, in which the abuse chiefly 
exists, to take some practical steps to secure themselves the protec- 
tion they desire. This undoubtedly could be done by one, possibly 
two visitors, and would entail a moderate outlay '* per capita " on the 
part of the membership of our District Societies ; but if the abuse in 
question is what we believe it to be, the expense would be well repaid, 
especially to the younger members. At any rate, such a step would 
advance the question from the province of theory to practice. It would 



96 MEDICAL SOCIETY OF NEW JERSEY. 

need no special preliminary legislation and would show a commend- 
able professional spirit and determination to deal practically and sen- 
sibly with our problem. Should legislation then be required to enlarge 
the scope of the work» the results of such a plan would serve as a 
practical guide. 

T. Y. SUTPHEN. 

G. H. Balleray. 
F. D. Gray. 
J. D. Baer. 

Committee, 



Resolutions and Remarks on Licensing Opticians 
TO Adapt Glasses. 

CHARLES J. KIPP. 

Whereas. Attempts have been made in the past, and will doubt- 
less be made again, to enact a law by which persons not licensed phy- 
sicians are recognized as competent to adapt glasses to the e\e and 
are authorized by the State to practice this art, and 

Whereas, We regard the enactment of such laws as detrimental 
to the welfare of the people for the reasons below given; be it 

Resolved, That the Legislative Committee be and are hereby 
instructed to use, in the name of this Society, ever)' honorable means 
to prevent such a bill from becoming a law. 

The reasons for this action are so ably stated by Dr. C. A. Oliver in 
"The System of the Diseases of the Eye" that we copy them. 

" The science of prescribing for ametropia (eyes out of focus) is not, 
as has been so widely supposed, a mere mechanical art, similar to the 
fitting of gloves and the measuring for boots. It is the work of the 
educated physician, who, understanding the significance of eye-strain, 
its bearing on the general health, and its proper medical treatment, is 
able to care for the case. It is he who should be the one to decide 
for the patient. It is he who is the one upon whom responsibility 
for the individual not only rests, but who exerts also a far-reaching 
influence upon men at large and their actions. 

•* In its treatment the eye should not be considered as a mere math- 
ematical or geometric contrivance governed by optical laws that neces- 
sitate mechanical adaptation of focusing materials similar to those 



LICENSING OPTICIANS TO ADAPT GLASSES. 97 

used in the various instruments of optical precision. The visual ap- 
paratus must be thought of as one of the physical structures of the 
entire organism, and subject to the same laws of physiologic action 
and disease as any other organ in the economy. The visual bulb is 
an end organ, and not simply an optical contrivance, like a microscope 
or a telescope, to look through. It is a living mechanism wherein 
rays of light are changed into a physical material that is capable of 
being evolved into perceivable matter. The popular comparison of 
the eye to a camera is erroneous and harmful. 

*' The diflficult or impaired vision that the patient comes complaining 
of is but one of many symptoms— the most prominent subjective one— 
that constitutes the signs of the disorder ; so that in the treatment of 
the condition optical correction becomes but a part of the thereapy, 
and should be ordered only by the competent medical man ; not com- 
petent merely in the sense of being one who possesses a medical 
diploma, but competent in the fact of having had a broad medical 
education and sufficient knowledge of .diseases of the visual appara- 
tus to treat them understandingly." 



Report of the Committee on Legislation. 

Your Committee on Legislation begs leave to make the following 
report : 

We feel that we can not better begin this report than with *an ex- 
tract from what was presented to yo«r body by this Committee one 
year ago — that medical men in the past have been negligent of their 
duties political. The members of this Society who took any part 
during the last session of the Legislature in attempting to shape legis- 
lation or prevent the enactment of vicious measures, are thoroughly 
convinced that the time has arrived that we, as a State organization, 
should be cognizant of and take an active interest in all matters com- 
ing before the Legislature of a medical or sanitary nature. 

It has become absolutely necessary that there should be legislative 
organization in the State Society, and this should extend to each Dis- 
trict Society; and if there is hearty co-operation of the officers x>f the 
State Society and of the several District Societies, we feel that when 
the medical profession is a unit, it will be a comparatively easy matter 



98 MEDICAL SOCIETY OF NEW JERSEY. 

to readily dispose of vicious bills that are introduced into the Legis- 
lature, as well as to secure the passage of healthy legislation, which 
will be a benefit to the State at large. 

There has been no time since the Chairman of this Committee has 
been connected with legislative matters which were vital to this Society 
at which there have been so many vicious bills introduced into the 
Legislature as during the past year. 

The bill which was fathered by the undertakers, giving them the 
power to disinfect houses, look after the sanitary conditions, and the 
right to issue permits for the interment of the dead ; the Optometery 
bill, practically giving unlimited rights to a class to examine eyes and 
fit glasses, are examples of measures introduced at the last session of 
the Legislature. 

Your Committee met in December last in Philadelphia, at which 
time there were present Drs. Strock, Leal and your Chairman. Fol- 
lowing your instructions at the last session of this Society to prepare 
a bill to be introduced in the Legislature embodying Dr. Strock's ideas 
for the protection of the physician on the witness stand, we had a 
bill carefully drawn by an able lawyer, and early in the session it was 
introduced by the member from Gloucester County. After much hard 
work with the Committee, notwithstanding that there was a great deal 
of opposition to the bill, and after your Committee had agreed to certain 
amendments which the opposition in the House said would be accept- 
able to them, it was favorably reported by the Committee to the 
House. Here it hung fire for a long time, but was finally defeated in 
the House toward the close of the session. The members who 
opposed it gave as their excuse that it would practically preclude 
them as lawyers from obtaining valuable evidence in divorce cases. 
We feel that if there had been hearty co-operation of the District 
Medical Societies in which the respective members of the Legislature 
had been interviewed, and the measure explained to them, we would 
probably have passed it. Bpt an opening has been made, and if it 
should be the desire of the State Society, it is possible to have the 
matter re-introduced at the coming session of the Legislature, when, 
with good work upon the part of us all, we believe that it will become 
a law. 

The Undertakers' and Optometery bills were disposed of in Com- 
mittee, largely, we believe, through the exertions of your Committee 
on Legislation. 



REPORT OF COMMITTEE ON LEGISLATION. 99 

The most serious matter coming to our attention was the bill to 
license Osteopaths. After having obtained a hearing before the Com- 
mittee on Public Health, we called together prominent physicians 
from all over the State to assist us to squelch this species of quackery. 
The President of pur Society, Dr. Godfrey, made an able argument 
against the bill, taking up principally the legal side of the question. He 
was followed by Drs. Robert T. Morris and Frank Van Fleet of the 
Medical Society of New York, who kindly came to our assistance and 
rendered us valuable aid. These gentlemen carefully analyzed Osteo- 
pathy, showing that it was nothing new ; simply a form of massage and 
manipulation employed by all progressive medical men in selected 
cases ; that if this bill became a law it would allow persons who 
claimed ability to treat diseases by peculiar methods to evade the 
medical laws, and place a premium on ignorance; that it is certainly 
not the part of wisdom to legalize certain peculiar methods of treat- 
ing diseases, and restricting doctors to the practice of them. No 
intelligent and educated physician would feel that he could conscien- 
tiously practice his profession unless allowed to use his judgment as 
to the method he employed. No two cases of the same disease are 
exactly alike ; peculiarities arise sometimes and require modifications 
of treatment. It is not possible for the State to discriminate between 
methods of treatment. The best that the State can do is to insist 
that all people who treat diseases shall demonstrate to an impartial 
board that they are competent to diagnose diseases, and are familiar 
with the known methods of treatment. The State laws leave the 
application of the particular method of the particular disease to the 
discretion of the physician. If an exception is made in favor of these 
so-called Osteopaths, an invitation is given to charlatans of all sorts 
to come in and ask similar privileges. This is not only not in the 
interest of the people of the State of New Jersey, but it is an unjust 
discrimination against the medical profession of the State, which, 
whatever its faults may be, is made up pf men and women who are 
peers of any in the land, and whose ability is limited only by the dis- 
coveries of scientific knowledge. 

Several other members of our State Society made able pleas against 
the passage of this bill, and we were assisted by our homeopathic breth- 
ren. The President of the New Jersey State Homeopathic Medical 
Association made a strong argument against the passage of this 
measure, and claimed that these men should come under the general 
medical law, and should not be permitted to practice as a special class. 



ICX> MEDICAL SOCIETY OF NEW JERSEY. 

The Ostespaths w«re represented by a number of their followers, 
and their spokesman made a very rambling argument in support of 
the measure: his plea was largely the citation of cases in which 
Osteopathy had done so much after the failure of regular physicians. 
This bill was disposed of in Committee, never having been reported 
to the Senate. But in the judgment of your Committee, they will 
undoubtedly try again at future sessions of the Legislature, and it will 
be necessary for us to make a campaign of education against this 
measure. It is sometimes a difficult matter to convince members of 
the Legislature that any class of charlatans should not have the right 
to practice medicine even under an assumed name ; and we must be 
very alert to stamp out this quackery, as it would only be an entering 
wedge for numerous others of the same class. 

Your Committee assisted in passing the bill to raise the medical 
standard in the State, which now places us practically on a par with 
the requirements of the State of New York. 

Your Chairman sent out letters to all the District Societies, calling 
their attention to the resolution passed at the last meeting of the 
State Society, instructing the Chairman of the Committee on Legisla- 
tion to correspond with the several District Medical Societies and ob- 
tain a concensus of opinion as regards the fees for the examination of 
lunatics, for conducting post-mortems, and as witnesses at coroner's 
investigations. Also, to obtain, if possible, the number of irregular 
practitioners throughout the State, and the number of regular practi- 
tioners who are not members of the District Medical Societies. With 
very few exceptions, your Chairman has had no report from the Dis- 
trict Societies ; certainly not enoigh to make a report to the State 
Society. And in regard to the questions asked of the several District 
Societies as to the charges, your Chairman is sorry to say that in only 
two instances has he received notification of any official action from 
any of the District Societies throughout the State. 

We feel that this Committee on Legislation is of such vital import- 
ance to our interests that it should be enlarged to one member from 
each District Medical Society ; believing that in this way we may 
more quickly and successfully reach the members of the Legislature, 
as each member of the Committee would then have a duty to perform. 
We would suggest that you further instruct your Committee at this 
session to obtain, if possible, before the next meeting of the Legisla- 
ture, answers to the questions which have been submitted to th« Dis- 



REPORT OF COMMITTEE ON LEGISLATION. lOI 

trict Societies, and that they have the power to draft a bill to be 
presented at the coming session of the Legislature covering the fee 
question in cases of lunacy, post-mortems, and witnesses at coroner's 
inquests. 

Your Committee desire to express their sincere thanks to our 
Recording Secretary, Dr. Chandler, who has always been very ready 
and prompt to assist us whenever called upon, and it was entirely 
through his influence that we obtained the assistance of the gentlemen 
from New York in our fight against the Osteopathic Bill. 

The Committee is of the opinion that the term Osteopathy is a mis- 
nomer as applied to a method of treatment that consists chiefly of 
massage and the use of the Swedish movements ; that the claims 
made for refinement of diagnosis cannot be substantiated ; that the 
cures of gross lesions cannot be demonstrated, and that the benefits 
derived from the so-called Osteopathic treatment is not greater than 
usually results in the practice of skilled Masseurs. It is not a sys- 
tem of medicine, and its propaganda is in the hands of those skilled 
in deceit. 

The Committee is not prepared to say that (he practice of this system 
can be suppressed ; but it suggests that it can be controlled, in the 
same way as is the legitimate practice of medicine in this State. Com- 
pel every applicant for license to practice to observe the requirements 
of the law establishing the State Board of Medical Examiners, and the 
amendments thereto, with proper modifications, as is done with Hom- 
eopaths and Eclectics. 

The Committee is of the opinion that the fee for examination of 
indigent insane should be at least five dollars. This would be but a 
minimum sum for the time consumed and responsibility incurred in 
the performance of the duty. 

A post-mortem examination of a body, ordered by a coroner or 
county physician, should command a fee of from $25.00 to $100.00, 
according to the thoroughness of the dissection required. 

A physician summoned to give testimony at a coroner's inquest, in 
the county in which such physician resides, should receive a fee of 
$5.00. If summoned to a neighboring county, the fee should be 
$10.00. The above fees should prevail if the physician is summoned 
to give similar testimony in court. 

The Chairman of the Committee desires to express his appreciation 
of the services of Drs. Strock, Baldwin and Leal. They have been 



I02 MEDICAL SOCIETY OF NEW JERSEY. 

ever ready and anxious to do all in their power to assist in either the 
passage of measures, or working industriously against bad ones. 

The Cornmittee has not been able to accomplish all we had hoped 
for ; but we have made a gallant fight to the best of our ability to 
prevent the passage of measures which were detrimental to the med- 
ical profession of our fair State, and to uphold the honor and dignity 
of the Medical Society of New Jersey. 

All of which is respectfully submitted. 

L. M. Halsev. 

A. K. Baldwin. 

Daniel Strock. 



PRESIDENTS ADDRESS. 

BV E. L. B GODFREY, A. M., M D., 
CAMDEN. N.J. 



The Educational Standards of the Medical 
Profession of New Jersey, Past and Present. 

The history of New Jersey shines resplendent in the glory of great 
actions and high achievements. Not alone in the arts of war or of 
peace are these achievements renowned, but also in the domain 
of science, they glow as beacon lights in American medicine. 
What the medical profession of New Jersey has accomplished in 
establishing and maintaining high educational and professional stand- 
ards, from the first examinations inaugurated in 1772 to the present 
requirements for examination and license, is the theme to which I beg 
to call your attention to-night. 

In the early period of the Colony of New Jersey, medical practice 
was without regulation save by the crude laws promulgated by the 
Duke of York. But, with the advent of the Puritans and the Knick- 
erbockers of East Jersey, under Berkeley and Carteret, and of the 
Quakers of West Jersey, under Fenwicke and Byllinge, there came 
physicians whose training in the schools of Europe made them leaders 
among the early settlers. Their interest in local government and in 
their profession, especially in the practice of inoculation at this period, 
materially contributed to their influence. 

But comparatively little progress was made in a professional way 
in the Colony of New Jersey until the close of the French and Indian 
war in 1763. This war, according to Dr. Toner, gave the native phy- 
sicians opportunities to note the methods of practice current with 
English army surgeons stationed at the military hospitals located at 
Burlington, Trenton, Perth Amboy and New Brunswick. These 
opportunities stimulated their professional knowledge and pride so 
that, according to Dr. Wickes, they organized, three years later, in 
1766, the Medical Society of New Jersey. In the first year of its ex- 
istence the Society took up the subject of medical education. It was 
agreed that " No member should take a student as his apprentice who 



I04 MEDICAL SOCIETY OF NEW JERSEY. 

did not possess a competent knowledge of Latin and some knowledge 
of Greek, and agree to remain as an apprentice to the master for four 
years, three of which should be spent with the master and the last in 
some school of physic." Thus an educational standard was estab- 
lishedlby this Society one hundred and thirty-six years ago. 

Six years later, in 1772, the Society secured a legislative enactment 
regulating the practice of medicine within the Colony. This provided, 
in^substance, that no person should practice medicine until he had 
been first examined in physic and surgery by any two Judges of the 
SupremejCourt, assisted by such persons as they saw fit. Thus State 
medical examinations were legally established in New Jersey one hun- 
dred and thirty-one years ago. 

f By this enactment, the Society became a potential factor in the Col- 
ony and, during the War of Independence, its members rendered the 
greatestjservice to the State, both in council and in the field, by reason 
ofjtheir high education, professional zeal and exalted patriotism. 

At the close of the Revolution and immediately following the 
institution of the State of New Jersey, this Society, in 1784, procured 
the re-enactment of the Colonial law requiring State medical examina- 
tions. These examinations were conducted through the medium of the 
Supreme Court, and were requisite for medical practice and for mem- 
bership in this Society. This method of examination instituted in 
1772 was continued until 181 6, a period of forty-four years, when the 
Stale transferred the examining and licensing power from the Supreme 
Court to this Society, conferred upon the latter the authority to deter- 
mipe^the qualifications of candidates for license, to grant license to 
practice medicine, and to confer the degree of Doctor of Medicine. 

In the light of to-day the granting of such authority to this Society 
would be regarded as unconstitutional. The State cannot delegate its 
authority to any organization, since all State officers must be either 
elected by the people or appointed by the Governor ; nor can any 
Governor be limited in his appointments to any list selected by any 
specific society, though he should be willing to listen to reasonable 
recommendations. 

The^Society at that time (1816) required an apprenticeship of four 
years, or three years if possessing a liberal education, including attend- 
ance upon at least one course of medical lectures, as a requirement for 
admission to the examination. The examinations were held in 
Materia Medica, Pharmacy, Chemistry, Anatomy, Surgery, Midwifery 



president's address. 105 

and Theory and Practice of Physic. From the first this Society, 
throus:h its examinations, guarded with jealous care the portals of the 
profession. In 1849 it endeavored to nationalize its system of licensure, 
and urged the American Medical Association, organized two years 
previously, to endorse the separation of the teaching from the licensing 
powers and the establishment of State examinations for State license. 
College influence, however, proved too strong, and the resolution was 
not carried out. 

The Society believed in the establishment of a legal standard of 
medical education. In order to still further advance that of New 
Jersey, the Society, in 1851, endeavored to secure from the Legislature 
a supplement to the Medical Act, embracing still higher ideals. 
Among other provisions, it included a four years course of medical 
study from applicants without a diploma in the Arts, as a basis for 
its examination and license. This movement caused much excitement 
among the medical colleges of adjacent States. They raised the cry 
that the censorship of the Medical Society of New Jersey was inimical 
to public and professional interests. The College of Physicians and 
Surgeons of New York, the University of New York, the University 
of Pennsylvania, Jefferson Medical College, and Pennsylvania College 
joined interests in opposing this measure. They secured an amend- 
ment to the supplement compelling the Society to grant a State license 
to their graduates upon the presentation of their diplomas with fees 
and testimonials as to character. 

For the first time in its history, the Legislature thwarted the inter- 
ests of the Medical Society of New Jersey. 

The execution of this law became at once a source of embarrass- 
ment to the Society because of its limitations and the favoritism 
shown to the colleges named. The act not only practically abrogated 
the examining authority of the Society, but placed a premium upon 
graduation from these colleges and exacted the penalty of examina- 
tion from the graduates of all other medical schools. As a result, a 
feeling of dissatisfaction pervaded the profession. To meet this, the 
Society adopted conciliatory measures by admitting graduates of any 
regular medical school to practice in this State without examination. 
But this concession failed to stem the tide of opposition to the exam- 
inations of the Society from the graduates from other schools and 
systems of medicine. This enactment was so manifestly unjust that 
the graduates of other medical colleges secured from the Legislature, 



I06 MEDICAL SOCIETY OF NEW JERSEY. 

in 1854, the enactment of a law granting to all physicians holding^ 
diplomas from any medical college in any State of the United States, 
after three years of study with a lawful practitioner, including two 
full courses of lectures of not less than twelve weeks each, to practice 
in this State upon depositing an English translation of their diploma 
with the Clerk of the County in which they resided. 

In this struggle between the Society and the colleges, from 185 1 to 
1854, the Society was clearly beaten. The examining and licensing 
power of the State, first exercised through the Supreme Court from 
1772 to 1 816, a period of 44 years, and through this Society from 
1 8 16 to 1854, a period of 38 years, making a total of 82 years, was 
completely abrogated, so that the Society, at its centennial anniversary, 
1866, surrendered its examining and licensing privileges and rights to 
the State, after holding them for 50 years. 

This was the darkest hour in the educational history of the medical 
profession of New Jersey. The profession was practically over- 
whelmed by these enactments. The standards were not only lowered, 
but the portals of the State were thrown wide open to every kind and 
grade of physician, from any and every State, even from the bogus 
medical colleges which began to flourish at this time. The profession 
was despoiled of much of its former dignity ; quacks and pretenders 
abounded everywhere throughout the State and plied their vocation 
unmolested. There were no laws governing the practice of medicine 
in New Jersey, except the recording of a copy of a diploma with a 
County Clerk, and this was indifferently enforced because the Clerk 
was unable to distinguish between genuine and fraudulent diplomas. 
This condition of affairs extended until 1880, a period of 26 years, 
when, owing to the public scandal caused by the bogus medical col- 
leges and exposed by the lay press, chiefly by the Philadelphia Record^ 
the filing of a fraudulent diploma was made a misdemeanor. 

During this period of twenty-six years, private medical schools, 
without endowment and proprietary in character, sprang up with 
mushroom-like growth in nearly every city in the adjacent States. 
Their reputation and success rested largely upon the number of stu- 
dents they could graduate in two courses of lectures of sixteen to 
twenty-four weeks each, each course a repetition of the other. In 
none of these colleges was an entrance examination required. , But 
the low grade of requirements, supplemented by a still lower grade 
of teaching, was not sufficiently low to accommodate many desirous 



PRESIDENTS ADDRESS. I07 

of practicing medicine ; consequently bogus medical colleges flour- 
ished -luxuriantly in New Jersey as well as in adjoining States. Phy- 
sicians multiplied so rapidly that a medical diploma had but little 
significance and was no evidence, per se^ of a reasonable medical 
knowledge. In fact, hundreds of persons practiced medicine in New 
Jersey who had never graduated from a medical school. 

The act of 1880, and its supplements, proved a failure, and medical 
practice in this State remained practically without restriction from 
1854 to 1890, a period of thirty-six years. 

During this period, the brilliant researches of Lister, Pasteur, Koch 
and others, with the practical experiences afforded by the Civil and 
Franco- Prussian Wars, revolutionized medical practice and gave new 
conceptions of the cause, nature and treatment of disease and injuries. 
Public and professional sentiment became aroused to the low educa- 
tional status of medical colleges, a large percentage of which 
were unable to give a proper course of instruction for want of 
endowment. The demand for State regulation of the practice of 
medicine became imperative; not alone to protect the people, but 
also to advance the cause of medical education and sanitary science. 
The discussion of the subject was general. The controversy devel- 
oped that no government, neither the United States nor foreign 
powers, granted the right to practice medicine on a medical diploma 
issued by a private teaching institution, except our State governments. 
The United States, like the foreign powers, refused to accept a medi- 
cal diploma as -a test of qualification, and exacted examination from 
all applicants for admission to the medical corps of its Army and 
Navy. Various States took up the problem to discover a solution. 
The conclusion was reached that, in view of the authority exercised 
by physicians over the health of its citizens, a State should not accept, 
without examination by its own officers, a diploma from a college 
outside of its jurisdiction, especially from private medical institutions, 
owned and controlled by their faculties. Investigation showed that a 
large percentage of medical diplomas represented more of a commer- 
cial than a professional value. It, therefore, became necessary for 
States to exercise their inherent right to regulate medical practice by 
mandatory enactment and to dictate the qualifications required for 
medical license. The need for this action was the greater because 
there was no fixed or accepted standard of medical education in the 
colleges. 



I08 MEDICAL SOCIETY OF NEW JERSEY. 

In accordance with the spirit of the times, the State of New Jersey 
established, in 1890, a minimum standard of medical qualifications and 
appointed direct representatives to examine and license, in the name 
of the State, all persons hereafter commencing the practice of medi- 
cine within its borders. Unlike the delegated authority exercised by 
the Supreme Court and by this Society, these appointments were 
direct and for the exclusive purpose of ascertaining and certifying to 
the fitness of applicants for a State license. These representatives 
were appointed as State officers, for State duties, and were directly 
responsible to the State for their actions. 

At this time the short period of study required to obtain a medical 
diploma did not warrant the establishment of very high academic and 
medical standards, while the long period of unregulated medical prac- 
tice would have made it difficult to enforce them. Three classes of 
licentiates were provided for by the statute of 1890. Graduates in 
practice for more than five years were examined in seven branches 
of medicine ; graduates of less than five years* experience were exam- 
ined in fourteen branches, and undergraduates were given a partial 
examination, to be completed after graduation. No fixed period of 
academic and medical study was at first required by the statute ; 
after January, 1892, three years of medical study was required from 
the second and third classes, with evidence of some preliminary edu- 
cation. 

The Act of 1890 was not satisfactory in its scope or its require- 
ments, and was revised in 1894. 

The Act of 1894 required a competent, common school education 
and four years of medical study, including three courses of lectures 
in different calendar years, prior to receiving the degree of Doctor of 
Medicine, with testimonials as to character, as conditions of admission 
to the examination. The examination embraces fourteen subjects in 
nine sections, ten questions to each section, and a general average of 
75 per cent, to obtain a State license. 

This act marked a great advance in the medical standards of New 
Jersey and has served a grand purpose. It has been extensively 
copied by other States. When enacted, it was abreast of the times, 
but the progress of medical science in the last decade demands still 
higher academic and medical education. It became necessary to revise 
the law to keep in touch with the examining requirements of other 
States. This revision would have been made earlier had it not been 



president's address. 109 

or the difficulty in establishing a satisfactory public school law, which 
was necessary to fix the limit of academic requirements. 

The Act of 1894 was amended on April 8th, of this year, after con- 
ference with the Governor, the medical representatives of the State, 
and consultation with a number of the leading physicians of the State. 
Its provisions go into effect July 4th. 

The academic requirements are raised by the amendment from " a 
competent, common school education " to a diploma issued after four 
years of study in a normal, manual training or high school of the 
first grade in this State, or in a legally constituted academy, seminary 
or institute of equal grade, or a student's certificate of examination 
for admission to the freshman class of a reputable literary college, or 
an academic education considered and accepted by the State Super- 
intendent of Public Instruction as fully equivalent. These require- 
ments are now demanded by the best colleges. 

By this means the State secures a fair amount of academic educa- 
tion in its licentiates, while debarring none from its examinations by 
reason of limited educational opportunities. The public high schools 
are free to all, and if unable to attend these institutions, the candidate 
may go before the State Superintendent of Public Instruction, or the 
State or County Boards of Examiners for Teachers, and demonstrate by 
examination his fitness to be admitted to the medical examinations. 
The rich and the poor stand on an equal footing. It is the quality of 
the education and not the place or circumstances under which it is 
obtained, that is requisite. Aristocracy in medicine is neither cstab 
lished nor encouraged by this law. 

The minimum medical requirements for a State license are four 
full school years of medical study, of at least nine months each, 
including four courses of lectures of at least seven months each, in 
four different calendar years, in a legally incorporated American or 
foreign medical college, prior to receiving the degree of Doctor of 
Medicine. This is the basis of graduation in the best medical col- 
leges, and places New Jersty on a par with the adjoining States. The 
State has thus made steady progress in raising the requirements for 
its license since its examinations were established in 1890. No State 
examination preliminary to the study of medicine is required, because 
New Jersey has no medical colleges. 

The examinations for medical license are conducted strictly within 
the provisions of the statute. It has been found that written exami- 



no MEDICAL SOCIETY OF NEW JERSEY. 

nations are the best available test. The State only demands that a 
candidate meet its minimum requirements, which indicate the posses- 
sion of a reasonable medical knowledge. Candidates are known by 
number only to the examiners. The rules are such that fraud, im- 
personation or favoritism are practically impossible. After the exam- 
ination, the entire record of each candidate, embracing his credentials, 
examination papers, averages attained, etc., is filed in the State Library 
for public inspection and as prima facie evidence of all facts therein 
contained. 

The new law makes concessions to veteran doctors. Five yeafs of 
reputable and continuous practice may be accepted for admission to 
the examination in lieu of one course of lectures, in the case of grad- 
uates prior to 1903 ; and ten years of practice for two courses of lec- 
tures in the case of graduates prior to 1894, provided that the exemp- 
tion be stated in the State certificate. These provisions are but just 
to those members of the profession whose practical experience is 
entitled to recognition and more than offsets the technical glibness of 
the tyro fresh from the arms of his Alma Mater. 

The need of State supervision over the admission of medical prac- 
titioners to the rights, privileges and immunities that the State grants 
to the profession is now admitted. Every State and Territory in the 
Union demands from each beginning practitioner a State medical 
license based upon examination, or a diploma from a recognized college, 
except Alaska, where a license fee of ^50 per year is required from 
itinerant physicians. Even Hawaii, Porto Rico and the Philippines 
require examination and licensure. 

By virtue of this supervision, the State guarantees to its citizens 
that its medical licentiates possess at least a reasonable knowledge of 
medical science. Wherever the standard of requirements and of the 
examinations has been scrupulously maintained, and all candidates 
for license placed upon the same footing, no matter from what college 
they were graduated, there State supervision has been a potential 
factor for the public good. It has extended the curriculum of medical 
study and promoted the cause of medical education more than any 
other factor. It has forced colleges to adopt as least the minimum 
requirements of the States. It has uplifted the morale of the profes- 
sion and driven unlawful practitioners from the State in great 
numbers. 

The best medical colleges advocate State supervision and high 



president's address. Ill 

standards for license because they alone can furnish the facilities 
necessary to obtain the required knowledge, and the laboratory nnethod 
of teaching which is now demanded by the progress in medical sci- 
ence. State supervision will reduce the poorly-equipped and unen- 
dowed colleges to the minimum, if it does not ultimately compel 
them to yield their charters. Private medical schools must go to the 
wall. These schools served their purpose and were useful when the 
country was sparsely settled and medical science was comparatively 
simple. Now they are unable to meet the demands of modern educa- 
tional methods. When it is remembered that there are 156 medical 
colleges in this country, with about 27,500 matriculants, graduating 
over 5,000 students annually ; that about 63 per cent, are private 
corporations owned and governed by their faculties, essentially 
private institutions, without endowment or the facilities for giv- 
ing a first-class medical education, and lax in enforcing the entrance 
examination, the need of State supervision over medical education 
and practice becomes apparent. Repeal the enactments of central 
jurisdiction over medical practice, and the requirements for the title 
of Doctor of Medicine would go back to a two-years' course as 
before. There is no other way of compelling an unendowed college 
to require four years of study except by the State making it a condi- 
tion of admission to its examinations. Much has been accomplished 
in this direction, but much still remains to be done. 

The State of New Jersey, through its medical representatives, 
exacts compliance with the high standards of the laws from all appli- 
cants for its medical license. No diploma has been recognized from 
any medical college of lower standard than the statute requires. 
Medical diplomas are not a certain indication of a reasonable medical 
knowledge, nor is the entrance examination agreed upon by the Asso- 
ciation of American Medical Colleges adhered to by all schools. A 
large number of candidates have been refused admission to the State 
examinations because unable to meet the requirements of the statute. 

The charters of two medical colleges have been revoked, and the 
establishment of a third, advertised to grant a diploma on a two-years' 
course of study, was recently defeated in the Senate after it had 
passed the Assembly. Hundreds of charlatans and pretenders have 
been driven from the State, and there is less fraudulent practice in 
New Jersey to-day than at any time in its history. The practice of 
osteopathy has been shown to be in violation of the statute by a 



112 MEDICAL SOCIETY OF NEW JERSEY. 

recent judicial decision. The Court held that no one should be per- 
mitted to administer and prescribe, as a practice, for the curing of 
disease, unless with the permission of the State, and that the State 
was to be the sole judge of any and all systems and of the fitness of 
the person to administer to the siclc ; that no one has a right to prac- 
tice any system whatever, medical or religious, such as the laying- on- 
of-hands, without a State license. This decision applies to Christian 
Scientists, whose belief that disease has no existence, but is a sin to 
be healed by prayer, is a menace to public safety. 

An especially gratifying feature of the operation of the statute is 
the progressive improvement in the personnel of candidates for a State 
license. A few years ago, about 5 per cent, of all candidates held 
degrees in the arts or sciences, including pharmacy. Last year, 21 
per cent, held academic or scientific degrees. Step by step the pres- 
ent medical statute has built up the educational standards of the pro- 
fession of New Jersey and has done more to dignify and ennoble it 
than any legislative enactment since the institution of State examina- 
tions, 131 years ago, except the incorporation of this venerable Society 
in 1790. 

The history of State examinations from 1772 to 1854. a period of 
82 years of high standards and professional worth ; the absence of 
examinations from 1854 to 1890, a period of 36 years of unrestricted 
medical practice without State standards ; the resumption of State 
examinations in 189Q, followed by steady improvement in both the 
State standards and the personnel of the profession— these facts of 
history show the acknowledged need, the great advantages and the 
unlimited possibilities of a system of medical licensure controlled and 
operated by the State alone. 

The value of a New Jersey certificate of license may be estimated 
when it is stated that, during the past year, only 82 per cent, of the 
graduates, representing about 40 different medical colleges, proved 
themselves capable of obtaining it. The number of licentiates during 
the past year added about 6 per cent, to the number oi physicians 
already in practice in this State, the proportion of doctors in New 
Jersey now being about i to 600 of the population. The demand 
of both the profession and the public is not for more, but for better 
educated physicians. 

Of the total number of physicians in New Jersey, about 69 per cent, 
hold the certificate of State license. A quack may flourish a diploma. 



PRESIDENT'S ADDRESS. II3 

but it is impossible for him to get the certificate of New Jersey under 
the present statute and the accessory rules and regulations. Fraudu- 
lent impersonation, also, is practically impossible. 

Because of these facts, the certificate of medical license issued by 
New Jersey confers an added dignity on those members of the pro- 
fession who have received it and renders them eligible at this time for 
license in perhaps more States than that of any other State of the 
Union. 

The present medical statute has been sustained by several Courts 
of Common Pleas, Supreme Court Justices and the Court of Errors 
and Appeals. The enforcement of the penalties of the statute rests 
wholly with the prosecuting authorities of each county. The co- 
operation of this Society and the District Societies with the Prosecu- 
tors, through committees formed for that purpose, with whom the 
representatives of the State would willingly work, would greatly aid 
in the enforcement of the statute. To make the law more effective, 
it is the purpose of the State to secure legislation making the display 
of a sign, circular or advertisement, or any other device to advertise 
as a practitioner of medicine, or of any of its branches, without 
license, in itself a misdemeanor, punishable by fine or imprisonment. 
When this is done, the protection of the citizens of New Jersey 
against medical pretenders will be complete. 

The perplexing question, gentlemen, in the maintenance of the edu- 
cational standards of this State, is the endorsement of licenses issued 
after examination by other States. This perplexity arises from four 
causes. The unsettled state of medical education throughout the 
country ; the wide variation in the curricula of the 1 56 medical col- 
leges, in respect to their entrance examinations, methods of teaching 
and requirements for graduation ; the differences in State laws regu- 
lating medical practice, arising from the varying needs of different 
States according to their public school standards and extent of popu- 
lation; the diversity of opinion in the profession itself as to what 
should be required to obtain the title of Doctor of Medicine and 
State authority to practice, contribute complications to the solution of 
the question on a common and equitable basis. 

For the past thirteen years the National Confederation of State Medi- 
cal Examining and Licensing Boards has considered the question of 
reciprocal endorsement without reaching a solution. For the past 
three years the Confederation of Examining and Licensing Medical 
Boards of the Middle West has been wrestling with the subject, and, 
8 



114 MEDICAL SOCIETY OF NEW JERSEY. 

in April last, proposed a double standard for endorsement — one upon 
a State certificate of examination' and license ; the other, upon a 
diploma from a recognized college. This is the method that wrecked 
the examinations of this Society in 1851. How utterly it compromised 
the Society in the favoritism shown to certain colleges ; how thoroughly 
it failed to accomplish the end in view, the history of this Society 
attests. Such will be the result of any system that fails to exact from 
all candidates for license the same minimum qualifications or accepts 
the diploma of any college in lieu of a State examination. 

What, then, can be done to harmonize conflicting opinions on the 
question of State standards without undue severity on the one hand 
or undue laxity on the other ? 

Let us consider the subject from various view points. Shall every 
applicant for license undergo an examination in this State after pass- 
ing an equal examination in another State having equal standards of 
requirements ? 

Take a hypothetical case. Assume the case of a physician, gradu- 
ate of a reputable medical college, licensed after a State examination 
equal in grade and kind to that of New Jersey ; who has practiced 
five, ten or more years ; who desires to remove to this State because 
of health, family or professional reasons ; who can meet every 
requirement of the law, moral, educational and examining — shall the 
experience of such an applicant be wholly discounted and he be com- 
pelled to submit to a repetition of an examination in the same elemen- 
tary branches in which he was previously examined and passed when 
he first obtained his State license ? Is there any physician of five or 
more years' practice here present who would approve of this course in 
his own case ? Probably not one. 

Such an examination seems uncalled for. It is a hardship. It reduces 
the best men to the level of the lowest. It is unnecessary because 
professional efficiency has been once proven by a co-equal State. It 
is contrary to the spirit of the profession, because it discounts experi- 
ence and places the distinguished practitioner on the same footing 
as the beginner. 

Should it be said that all lawyers beginning the practice of law in 
New Jersey are compelled to pass a State examination for license, 
except when in consultation with the attorney of record in a given 
case, let it be remembered that, in law, statutes and court procedures 
differ in different States, while, in medicine, the principles and practice 
are the same in all the States. 



president's address. 115 

If, then, a repetition of a State examination, or a re- examination in 
essentially the same branches, upon removing from one State to 
another, is a hardship to the profession, what then is the best, the 
broadest system of interstate endorsement of State medical license ? 

There are two systems in vogue. The first restricts by statute the 
endorsement of licentiates to those States which reciprocate by grant- 
ing equal rights in return. The second is also statutory, but leaves 
endorsement optional with the licensing authorities, provided the 
standard of requirements of reciprocating States are substantially the 
same. 

Let us consider the first system, viz., endorsement restricted by 
statute to those States alone which reciprocate. What is the object 
of such restriction? It is to compel reciprocation from States to 
whom endorsement is given, on the ground that endorsement cannot 
be justly given when not granted in return. Will it accomplish this ? 
No ! No State can be compelled to reciprocate by any process of law 
or retaliation. The theory of compulsory reciprocity may seem to 
some, at first sight, just to the profession and good State policy. Ex- 
perience, however, proves it to be unjust to the profession and a bad 
State policy. It is not a success, and has proved a stumbling block 
to the extension of interstate endorsement. 

Of the 54 States and Territories of the Union, as far as can be 
ascertained, only 5 have compulsory reciprocity embodied in their 
statutes ; while in the remaining 49 endorsement is optional with the 
licensing authorities or not provided for by statute. 

What reasons, it may be asked, can be adduced to prove its injustice 
to the profession and its detriment to the State ? 

J. It makes a State medical certificate paramount to a diploma 
from the highest medical colleges and to the qualifications of the 
most distinguished practitioners in the question of endorsement . 
whereas, such certificates should be regarded as only co-equal with 
the several conditions of endorsement, in justice to the profession and 
the colleges. 2. The system is mandatory aad places an embargo 
on applicants of professional merit from States that cannot reciprocate 
by reason of higher requirements. This may be illustrated by the 
recent refusal of a certain State to accept the New Jersey certificate 
because New Jersey could not reciprocate an account of its higher 
standards — an injustice at once manifest. 3. Its application is lim- 
ited, because State medical laws are not uniform, and the limitation 



Il6 MEDICAL SOCIETY OF NEW JERSEY. 

will continue for years on account of differences in population and in 
the grade of public schools in the different States. 4. Its tenure » 
also, is uncertain. The changes continually. being made in State laws 
to keep in touch with the progress of medicine will cause constant 
interruption of endorsement and consequent confusion and hardship 
to the profession. 5. It is contrary to the formulated ethics of the 
profession, because it is a revival of the " lex talionis " of the ancient 
codes. 

As a State policy, compulsory endorsement of those States only 
which reciprocate, if engrafted in the statute, would prove detrimental 
to the profession of New Jersey. Such reciprocity could not be 
entered into with New York or Pennsylvania, or other adjoining States, 
as has been suggested, because the statutes of these States do not 
recognize such a provision. Were such a system of reciprocity 
adopted, it would involve endorsing all the licentiates of reciprocating 
States, the good with the bad. It would mean, therefore, endorse- 
ment on the omnibus plan, since all the licentiates of a State stand on 
an equal footing. 

What would be the result ? The numerical ratio of the profession 
of New York to that of New Jersey, on the basis of the census of 
1900, is about 6 to I ; that of Pennsylvania to New Jersey, about 4 to 
I ; that of New York and Pennsylvania combined is approximately 
10 to I. New Jersey, therefore, is not the equal of the adjoining 
States either in population or number of physicians, and an exchange 
of medical licenses on the basis of equal rights and privileges in return 
would, in view of the great disparity as to numbers, prove detrimental 
to the profession of this State. Nor is this all. The influx of physi- 
cians for summer practice along the coast, in the mountains, by the 
lakes and at the suburban resorts, makes that system of endorsement 
still more detrimental. 

Reciprocity, therefore, restricted by statute or by voluntary agree- 
ment, which endorses the licentiates of those States only which recip- 
rocate, and on their State certificate alone, in the relative proportion 
existing between this and the two great adjoining States, with the 
inducements for summer practice found here, would literally engulf 
the profession of New Jersey. This is not a theory, but a fact. New 
Jersey cannot afford endorsement on this plan. The profession of 
New Jersey needs protection from itinerant summer practitioners, 
whose methods are not always ethical. The State authorities have 



president's address. 117 

checked this influx by refusing to recognize the certificate of any State 
as the sole requirement for endorsement, but demand that the holder 
shail meet the same requirements as applicants for examination. 

As a State policy, therefore, compulsory reciprocity is plainly objec- 
tionable. Like a two-edged sword, it would cut both ways. It is not 
needed in New Jersey for the protection of medical colleges, since 
there are none in the State; neither has it been adopted by the 
adjoining States. It would stand in the way of medical progress, 
since its adoption would exclude endorsement of all States having 
higher requirements. Instead, therefore, of compelling reciprocity, it 
would check the extension of interstate indorsement, to the disad- 
vantage of the profession. 

Let us now consider the second system, which permits indorsement 
by statute, but leaves its application optional with the licensing 
authorities. This is a step in advance over indorsement restricted by 
statute to reciprocating States, because it admits of a wider appltca-r 
tion through the discretion permitting the licensing authorities in 
selecting States to be endorsed. Where this system is in operation, 
it is carried out by a voluntary agreement between the reciprocating 
States to endorse each others' licentiates. This method is open to 
most of the objections which apply to compulsory reciprocity, and 
has been found impracticable in its execution. 

This impracticability is due to four causes, viz., the difference in 
State laws and in their interpretation ; the difference in the standards 
of requirements for State license ; the difference in the status of 
medical colleges, and the different opinions as to the eligibility of 
candidates rejected by one State for the examinations of another. 

When differences arise between State authorities over any or all of 
these causes, how can they be adjudicated ? By law } No ! There 
is no law, national, inter-state or State, to adjudicate these differences 
or to enforce any agreement which may exist. Such agreements, 
therefore, based upon voluntary action, may be broken at pleasure 
and without redress, to the discomfiture of the profession. 

This is the experience of the licensing authorities of this and other 
States. In the absence of uniformity of college and State require- 
ments, there is, therefore, at this time, no basis for common and 
united action which can be applied to any considerable number of 
States ; nor can there be, until the laws of the States become uniform. 

It has been suggested that a national enactment would solve these 



Il8 MEDICAL SOCIETY OF NEW JERSEY. 

difficulties and provide for inter-state endorsement on a common basis. 
This, however, is practically impossible. The National Govern^ 
ment has no jurisdiction within any State in respect to the 
police control of its citizens* under which department State exam- 
ination and license fall. Before a national enactment can be ob- 
tained there must be secured an amendment to the Constitution 
of the United States involving a surrender of State sovereignty on 
the one hand and a centralization of authority on the other. It is not 
probable that such an amendment would be ratified by three-fourths 
of the States, with the surrender of the control of the medical prac- 
titioners within their jurisdiction. A voluntary National Examining 
Board has been proposed, but such a board would have no legal 
standing and would be wholly without official recognition. 

In the absence of any national or interstate enactment, reciprocity, 
whether compulsory or voluntary, is impracticable, except to a limited 
extent, until there is uniformity among the States in respect to laws, 
requirements and grade of State examination. Each State must regu- 
late medical practice within its own borders. Especially must New Jer- 
sey do this, whose high standard of requirements must be maintained ; 
who has no jurisdiction over any medical college ; whose population 
already carries its full quota of the profession, and whose territory is 
invaded annually by large numbers of physicians for the purpose of 
summer practice. 

With the necessity of State examinations and license admitted, 
how can New Jersey maintain her educational standards and protect 
both the public and the profession while endorsing medical licentiates 
of other States ? It is admittedly not good State policy to exclude 
the citizen of another State who can conform, in all respects, to 
the requirements of this State ; on what terms, therefore, shall they 
be admitted ? The problem has been solved by the licensing author- 
ities of this State, after a wide experience, and has been carried into 
snccessful execution. What, then, is the solution ? Simply to de- 
mand and enforce the same requirements for license by endorsement 
as for license by our own examination. Ntw Jersey does not accept 
the license of any State as a sufficient ground for endorsement, A 
State license is accepted as only one condition of endorsement, and 
only for the examination it represents. Just as from applicants for 
examination, so from applicants for endorsement, the same minimum 
standards of academic education, medical training, moral character 



president's address. 119 

and examming requirements are exacted. In addition to this, the 
New Jersey certificate of either examination or endorsement cannot 
be obtained except upon the recommendation of a registered physi- 
cian of this State. It is not alone the State, but also the individual, 
that is endorsed. The refusal, therefore, of a State to grant endorse- 
ment in return does not afford a legal or valid reason for rejecting an 
applicant who can meet every requirement of the law. 

The individual merit and professional qualifications of each appli- 
cant stand foremost in the question of endorsement for a license of 
another State. These must be supplemented by a State examination 
in substantially the same medical branches and conducted under 
essentially the same rules and regulations as required by New Jersey, 
before any State license can be endorsed. If any candidate cannot 
meet the academic, moral, medical and examining requirements for a 
New Jersey license, this State is under no compulsion, statutory or 
voluntary, to endorse him, no matter what State license he may hold ; 
if he can meet the requirements, he may be endorsed on the certificate 
of any State whose standard of requirements is substantially the 
same as that of this State, when supplemented by a recommendation 
from the profession of New Jersey. 

This, gentlemen, is believed to be the best, and perhaps the only 
method by which the high educational standards of New Jersey can 
be maintained and the profession fairly and justly dealt with. By 
this method New Jersey is the sole judge of the qualifications of its 
medical licentiates. This is the intent of our law. Only the best 
practitioners are endorsed. The record of each candidate as well as 
his State license is the subject of specific inquiry, and itinerant 
physicians of doubtful standing are quickly discovered and easily 
excluded. 

This system, too, is in the interest of higher education. It permits 
the selection of applicants from any State in the Union, whose moral 
character and college training meet the requirements of our law and 
whose State examination is substantially the same as that of New 
Jersey. 

This system admits of National application of the principles of 
endorsement, because each State is the judge of the qualifications of 
applicants for license, whether examined or endorsed. It is the only 
system so far devised that will admit of National application. Up to 
the present time it has made the certificate of New Jersey acceptable 



I20 MEDICAL SOCIETY OF NEW JERSEY. 

to more States than that of any State in the Union. When the new 
law goes into effect, July 4, it will not be possible to continue the 
endorsement of a number of States now endorsed, because of our 
higher standard of requirements ; but other States of equal require- 
ments will take their place, and the new standards are so high that 
the profession of this State will be eligible for endorsement through- 
out the country, if the qualifications of the applicant are the basis of 
consideration. 

In conclusion, gentlemen, permit me to express my appreciation of 
the high honor you have conferred upon me in electing me President 
of the oldest, the grandest and the most influential State medical 
organization in America. 

In looking backward, we behold the birth of this Society nearly a 
score of years before our nation was established and our State was 
founded ; we look with conscious pride upon History unfolding from 
her ample pages the names of illustrious members, renowned in sci- 
ence, literature, politics and arms, and we witness with satisfaction 
the re-establishment of legally regulated professional standards in the 
interest of the profession. 

In looking around us, we behold this Society larger in membership, 
more potent in influence, and with a better understanding of its rela- 
tions to the State, than ever before. 

In peering into the future, we behold this Society going forth with 
a firmer purpose to grasp the secrets of advancing science, to extend 
the period of human life, and to join with the State in maintaining the 
highest educational standards that the progress of medicine warrants 
and the welfare of the people demands. 



hospitals and charitable institutions. 121 

The Organization and Operation of Hospitals and 

Other Charitable Institutions in the 

State of New Jersey. 

. BY WALTER B. JOHNSON, PATERSON, N. J. 

The paper here presented has been written for the purpose of indi- 
cating the steps necessary to be taken in organizing hospitals and 
other charitable institutions, and also to consider in a general way 
the various forms of management, and the methods to be used in the 
operation of such institutions, especially hospitals. 

Prior to the year 1877, any persons who were desirous of organiz- 
ing one of the various forms of Charitable Institutions and incorpor- 
ating the same in a legal manner were compelled to apply to the 
State Legislature for a charter permitting them to do so. 

The following act of the Legislature, Session of 1877, approved 
March 9th, was introduced and became a law, thus permitting any 
body of men or women to organize and incorporate for such pur- 
poses by acting in accordance with the provisions of this General 
Law without making special application to the Legislature for a charter. 

When for the purpose of meeting certain conditions, which make it 
necessary to care for indigent persons, an organization is contem- 
plated, it is customary for the persons interested to first make an 
effort to interest others, in order that the necessary organizers may 
be secured and the financial success of the effort assured. And for 
this purpose a prospectus should be prepared setting forth the needs 
for the proposed institution ; the necessity for the form of treatment 
which it is proposed shall be employed ; the estimated number of 
deserving persons needing the succor which such an organization will 
give ; the inadequacy of the present means of supplying the required 
aid, and the objects which such an organization will hope to attain. 

In this prospectus it should be distinctly stated that the association 
will be incorporated under an act of the Legislature of the State of 
New Jersey entitled : 

Laws of New Jersey. 
lYOQ-iSyy. Revision of Statutes, page IJ4J. 

An act to provide for the incorporation of associations for the erec- 
tion and maintenance of hospitals, infirmaries, orphanages, asylums 
and other charitable institutions. 

Approved March 9, 1877. 

P. L. 1877, p. 159. 



122 MEDICAL SOCIETY OF NEW JERSEY. 

Number of persons who may make certificate of association, — Sec- 
tion I. That any three or more persons of full age, a majority of 
whom shall be citizens of and residents within this State, who shall 
desire to associate themselves together for the purpose of the care, 
cure, nurture or maintenance of sick, injured, infirm, aged, indigent, 
deaf, dumb, blind, idiotic or insane persons, or of orphans, half- 
orphans or destitute children, or for any two or more of such purposes 
combined, may make, record and file a certificate, in writing, in man- 
ner hereinafter mentioned. 

Form of certificate, — 2. That such certificate in writing shall set 
forth— 

I. The name or title assumed to designate such association. 
II. The place or places in this State where the purposes of 
such association are to be carried out. 

III. The purposes for which the association shall be formed. 

IV. The names of the governors or directors who shall man- 

age its affairs for the first year of its existence. 

Certificate to be proved, acknowledged and recorded, — 3. That 
such certificate shall be proved, or acknowledged and recorded, as 
required of deeds of real estate, in a book to be kept for the record- 
ing of certificates of incorporation, in the office of the Clerk of the 
county where the principal purposes of such association are to be 
carried out, and after being so recorded shall be filed in the office of 
the Secretary of State ; the said certificate, or a copy thereof, duly 
certified by said Clerk or Secretary, shall be evidence in all courts and 
places. 

To become a body politic and corporate on filing certificate, — 
4. That upon making such certificate and causing the same to be 
recorded and filed as aforesaid, the said persons so associating, their 
successors and assigns, shall, by virtue of this act, be a body politic 
and corporate, in fact and in law, by the name stated in such certifi- 
cate, and by that name they and their successors shall have perpetual 
succession, and power to sue and be sued, plead and be impleaded* 
answer and be answered unto, in all courts and places whatsoever, 
to make and use a common seal, and the same to use at pleasure, and 
to purchase and take, have, hold receive and enjoy, any lands, tene- 
ments or hereditaments, in fee simple, or otherwise, and any goods, 
chattels, or property of any description, real or personal, and whether 
acquired by gift, grant, devise, bequest or otherwise, and the same to 



HOSPITALS AND CHARITABLE INSTITUTIONS. 123 

grant, convey* lease, assign, seltt or otherwise dispose of, for the pur- 
poses of said association. 

General powers, — 5. That the governors or directors of such 
association shall have power, from time to time, to make alter and 
amend by-laws, not inconsistent with the constitution or laws of the 
United States or of this State, fixing and altering the number of its 
governors or directors for the management of its property and the reg- 
ulation and government of its affairs, and providing for the classifica- 
tion of and the mode of increasing and perpetuating the governors 
or directors of the association, and the mode of filling vacancies in 
and removing any member from their number, and prescribing qual- 
ifications for membership of the association, and to appoint one or 
more superintendents or managers, and such other agents and officers 
as shall in their judgment tend to promote or advance any purpose of 
the association, and to prescribe their expected duties. 

Compensation for services not to be ailowed,'^t. That no gov- 
ernor or director of any association organized under this act shall 
receive, directly or indirectly, any salary or emoluments from such 
association, nor shall any compensation whatever be voted, allowed 
or paid by the governors or directors thereof to any governor or 
director for services, either as governor or director, or in any other 
capacity. 

Exemption from tax, — 7. That the property and effects of any 
association organized under this act, and held for its purposes, to an 
amount not exceeding five thousand dollars, shall not be liable to the 
imposition of any taxes. 

The persons who have become interested in the organization of the 
proposed charitable institution must then meet and decide to incor- 
porate. A certificate of incorporation should be prepared setting 
forth that it is the intention to form an association for the proposed 
object, and certifying to the name to designate said association, the 
place in which the purposes of the association will be carried out, the 
purpose for which said association is formed, and the names of the 
governors or managers who shall manage the affairs of the said associa- 
tion for the first year of its corporate existence. In witness whereof 
three or more of the said managers thereunto set their hands and seals. 

The governors so signing must then personally appear before a 
Master in Chancery of New Jersey, who must certify that he is satis- 
fied that the persons appearing are those named in the certificate, and 



124 MEDICAL SOCIETY OF NEW JERSEY. 

the contents having by him been made known, did acknowledge that 
they had signed, sealed and delivered the same as their voluntary act 
and deed for the uses and purposes therein expressed, and the certifi- 
cate of incorporation must then be filed in the office of the Clerk 
of the county and there recorded, and thereafter also filed in the office 
of the Secretary of State of New Jersey. 

The board of governors, managers or trustees thus formed must 
then, at a meeting regularly called, organize, adopt by-laws, setting 
forth the name and object of the association ; the relations and 
powers of the board of governors ; the membership of the association > 
the name and number of officers and their duties ; the formation of 
the necessary committees and the duties of the same; an article 
naming the medical staff, prescribing their duties and powers, and 
making provision for medical and surgical reports; provision for 
meetings, special meetings, and the necessary number required to 
constitute a quorum ; adopting a regular order of business for meet- 
ings of the board ; arranging for alteration or amendment of the 
by-laws at any meeting of the board for which notice of the proposed 
change has been given at a previous meeting. Also adopting by-laws 
for such other items as may be indicated for the proper government 
of the board, its officers, medical staff or employees. 

The hospital must be considered from two separate and distinct 
standpoints. First, that of the great Christian charity organized 
and adapted to the needs of suffering humanity ; standing ready to 
care for and succor the unfortunate of any creed, nationality or color, 
at any and all times anxiously endeavoring to carry on the work 
instituted by the Great Master. From this view-point the hospital 
appeals to the charitably disposed citizens of any community for aid. 
It is necessary that sufficient funds shall be annually accumulated to 
carry on this work, and the gathering of such funds is the most difficult 
problem which confronts the boards of managers of most of the 
charitable institutions. 

Unfortunately, the endowment funds are in most instances slow of 
accumulation, and constant effort is required to increase the annual 
donation and subscription list proportionately with the ever increas- 
ing annual expense, for with each year added burdens must be borne. 
More of the deserving apply for care and maintenance, new develop- 
ments necessitate changes in the facilities for work, and the arma- 
mentarium of the institution must be kept in perfect condition, repairs 



HOSPITALS AND CHARITABLE INSTITUTIONS. 1 25 

and alterations are constantly in demand, and nothing but " trust in 
God/' concerted action and steady work can pilot the management 
through the constantly appearing periods of despondency which at 
times seem to point to certain dissolution. The appeal for help must 
be made, and unless the response of the philanthropic is prompt and 
liberal, the work can not be satisfactorily carried on. 

From the second point of view, the hospitals of to-day represent in 
their management and operation the conduction of a great business 
enterprise. Large sums of money are invested in lands, buildings 
and appointments, and much money is annually expended for mainten- 
ance and pay of officers, nurses and employees. 

In every department of a well managed institution the most rigid 
economy must be enforced. Constant watch and strict attention to 
every detail of the daily work can only accomplish a uniformly satis- 
factory progress. 

The business of the hospital office in its relation with all of the 
employees of the house and with all who enter the hospital as private 
or ward pay-patients must be conducted in accordance with strict 
business principles. In counter-distinction to the charitable work, 
everything should be so arranged that in this department the best 
interests of the institution financially shall be primarily considered. 

There are three varieties of hospital management, two of which 
are left without choice in the selection of managers— the hospitals of 
municipalities, the hospitals of the Sisters of Charity. In the third 
variety, the hospitals conducted by boards of managers, governors or 
trustees, the question of which form of management is to be adopted 
is of vital importance, and it is somewhat difficult to determine, as 
some hospital workers of experience favor government by male 
boards, others female boards, and still others mixed boards— male and 
female. 

The male board inspires in the public mind confidence in the busi- 
ness management, but, unfortunately, in many instances the members 
are so much engrossed in their own business affairs it occasionally hap- 
pens that it is impossible to secure the services of a sufficient number 
who will become interested enough to continuously carry on the work. 
There is no doubt, however, of the ability of such boards if they are 
workers, to raise money in excess of the amounts which may be raised 
by others ; it is also certain that under such management the cost of 
maintenance is considerably increased. 



126 MEDICAL SOCIETY OF NEW JERSEY. 

Female boards of managers are most careful in their management 
of the finances, although, generally speaking, they are not able to 
raise as much money as male boards, and fail to inspire public con- 
fidence in their business sagacity. They are generally successful 
managers, and are always particularly strong in keeping the adminis- 
trative department (for the care of which they are by long training 
especially adapted) in most perfect running order. 

The mixed board, it would seem, might assimilate all of the good 
and eliminate all of the bad in the other two forms of government. 
Theoretically, it would most certainly seem that such a board would 
be the ideal form of management ; the writer, however, is not able, 
for lack of personal experience, to recommend it. 

When the constitution of the board of managers has been settled, 
the next most important consideration is the question of* the methods 
to be adopted in carrying on the work. The writer recommends with- 
out hesitation what might be called the departmental system. 



TT r President. 

"a^ Js«~r.';^'*™'- 5ofR„*^MT J Executive 

TION. I 3qj^j.^ ^f Managers. 



Finance. 

House and Grounds. 
Training School. 
President. 
Secretary. 
Treasurer. 
Representative, 
i^ Medical Staff. 

The hospital associations meet annually, elect officers and a board 
of managers. 

The officers are also the officers of the board of managers. The 
board of managers meet monthly, and three, or more committees, if 
desired, are appointed annually — finance, house and grounds and 
training school, the chairmen of which committees, together with the 
president and secretary, treasurer and one member to represent the 
medical staff, form the executive committee. This committee meets 
at least twice a month and conducts all the business between the 
meetings of the board of managers. At the meetings of the executive 
committee the minutes of the separate committee meetings are read 
and acted upon and the recommendations of the committee consid- 
ered, thus keeping the other members in touch with the work of the 
several departments. This form of government is equally applicable 
to the management of a hospital with or without a superintendent. 

In case the size of the hospital does not warrant the employment 
of a superintendent, the executive committee, through the chairman 



PRESENT METHODS OF EDUCATION. 1 27 

of the various constituent committees, acts in place of such an officer, 
dealing directly with the employees in the department under their 
special charge. 

If a superintendent is employed, he must be the official head of the 
entire household, responsible to the executive committee for the proper 
management of the institution, and it must be his duty to supply the 
cohesive force necessary to join together in harmony the working 
force of the institution, in the same manner that the skillful machinist 
assembles the integral parts of a great machine and sets and keeps it 
in motion. 



Report of Committee on Present Methods of 

Education From the Standpoint 

OF THE Physician. 

BY JOSEPH TOMLINSON, M. D.. CHAIRMAN, BRIDGETON, N. J. 

That the subject, upon which. this Committee was appointed to 
report, is a most timely one there can be no doubt. The discussion 
which it evoked at the last meeting of this Society, and the many 
expressions from individual members in private conversation, demon- 
strated conclusively that the Medical Society of New Jersey is alive to 
the evils and dangers of our present educational system. 

Since our last meeting many articles have appeared upon this sub- 
ject in the medical press and several papers bearing upon it have been 
read in representative medical bodies. Not only is the medical 
profession showing earnest and solicitous interest in this, but the 
laity, as well, are earnest in their protests against many existing con- 
ditions which threaten the physical welfare of school children. The 
daily press, as well as leading magazines and periodicals all teem 
with literature bearing upon the subject, and even public meetings 
have been called to consider and discuss it. 

The educational problem is a most difficult one, in which many 
factors are involved. Some of these factors are fixed and finite 
quantities, others are ever changing and infinite. The factor which 
concerns us most intimately as physicians is the pupil, the youth made 
of flesh and blood, with all the frailties and limitations of humanity. 
He is finite. His boundaries are fixed by the very laws of his being, 
the laws of growth and development, and he is ever under the thral- 
dom of heredity and environment. 



128 



MEDICAL SOCIETY OF NEW JERSEY. 



The factor which concerns the educator most intimately, is the vast 
field of knowledge, endless in vai^ft^ and unlimited in extent. This 
is inftnile. Science, philosor' ^literature, h^' «ent 

boundless and fascinating fi 
lead him into the study of 
tive thought. It is but n. 
and investigation, the 
problem tMMkk^'^ ^^ 
expense ^^H^^kentaL 
Years ^^^^^^m stu 

an c^^^^^^Hitin 




PRESENT METHODS OF EDUCATION. 1 29 

While the causes responsible for the diseases incident to school life 
are many, by far the most important are : 

1st. The early age at which scholars are admitted to the public 
school. 

2d. Too many studies and in many instances too many hours of 
study. 

3d. A lack of classification of scholars. 

4th. The lack of proper physical instruction in the public schools. 

The early limit of school age is fixed, in this State, at five years. 

Undoubtedly a great percentage of children who are sent to school 
at a very early age are sent there expressly for purposes of con- 
venience. They are sent there merely to be gotten rid of a few hours 
each day. It is not only manifestly very wrong to make a nursery of 
the public school, but it is even worse to subject such children, 
however light may be the task assigned, to a strain which is distinct- 
ively and especially injurious to very young children. I refer to the 
spirit of rivalry and ambition which is constantly being fostered by 
parents and teachers in the never ending talk about promotion, prizes 
and the relative '* smartness " of this, that or the other child. Children 
should be taught to study because it is their duty and for study's sake. 
The vanity both of teacher, child and parent, should be subservient 
to healthy, broad and normal development. 

The *• cramming " system incident to so many studies and the over- 
taxing of the memory not only results in disorders of the nervous 
system, but also in very superficial work and an entire loss of mental 
discipline. The number of studies is too great to make thoroughness 
attainable. 

We need a closer touch between educator and physician, even in 
the planing of the school curriculum, both as to the branches to be 
taught, and the number to be taught, the broadly educated physician 
should have a voice. The educator and physician must work to- 
gether, not spasmodically, but continuously and constantly. Each 
must comprehend broadly and intelligently the objective point, and 
each must bring to bear experience and training gained in his special 
sphere. Education means vastly more than a memorizing of facts, as 
tersely put by a well-known college president — " Education is above 
technical scholarship, and the power to think is better than the power 
to remember." 

The imperfect classification of school children is apparent. 



I30 MEDICAL SOCIETY OF NEW JERSEY. 

As children are brought together in the public schools they present, 
necessarily, great differences not only as to age and sex, but also as to 
their physical, mental and moral conditiens. We have a heterogenous 
mass of humanity, some weak, some strong, some tracable, some in- 
tractable, some cleanly, some uncleanly, some with the proper 
instincts and some of the degenerate class. 

The percentage of " atypical " or *' sub-normal " school children 
has been variously estimated by different authorities, a fair average 
would be at least ten per cent. The gradation should be both upon 
a physical and a psychological basis. 

The atypical child, ihose exhibiting malnutrition or organic disease 
and the " neurotics " should be properly classified, and it is quite as 
necessary to separate from normal children the degenerate, as to 
exclude from among them a case of smallpox or diphtheria. Many a 
gallows and jail would be cheated of its victim if this were done, and 
we would only be applying the principle upon which we so strongly 
insist in every other sphere of our profesTsional work, the principle of 
prophylaxis. 

It is not only cheaper but better from every point of view to take 
the child in hand at the critical period and reform him rather than 
wait until he has become a prey upon society. The proper and com- 
plete classification of scholars can only be accomplished by a thorough 
and more extended system of school inspection. Vast strides have 
been made in this direction, beginning in Boston in 1894, Chicago 
followed in 1895, New York City in 1897, Philadelphia in 1898, and 
many other smaller cities since. 

As far as I can learn there is no state law to cover school inspec- 
tion, and in every state except our own the school inspectors are 
authorized agents of the local boards of health. In this State the 
whole matter rests with the local boards of education and is optional 
rather than imperative, and the inspector is clothed with no special 
authority. An explicit state law, requiring a thorough examination 
to determine organic diseases and psychic conditions would accom- 
plish very much more. This should include country districts as well 
as cities and towns. 

Proper physical education would be of much benefit to the majority 
of pupils in the public schools, and is an absolute necessity to some. 

The term, physical education, is used in this connection in its 
broadest sense ; it is meant to include everything in the way of applied 



PRESENT METHODS OF EDUCATION. I31 

physiology, or hygiene, exercise* gymnastics, and recreation which 
may be indicated in an individual case. This branch should be 
taught as thoroughly and as systematically, and be as much subject 
to given requirements for promotion, as the regular curriculum of 
studies. 

This can only be done tinder the direction of a properly qualified 
membtr of the medical profession. 

There are abroad many so called " professors " of physical culture 
who, on the strength of a dozen lessons in certain forms of gym- 
nastics pose as capable instructors in this branch, and unless we are 
very careful the ignorant pretender will usurp the place in the public 
schools which none but a physician, and one with special training, 
is competent to fill. 

Systematic physical training is the basis of successful manual, as 
well as mental and moral training. Many educators are convinced of 
its importance, and would welcome any method by which it could be 
thoroughly and systematically accomplished. 

In order, therefore, to bring about a much needed co-operation 
between the educators and medical profession in this State, and in 
order also to have a more thorough and a more complete medical 
examination of all school children, as well to provide and insure 
means for their proper physical development, this committee respect- 
fully recommed that this matter may be referred to a committee from 
this Society, to report at its next meeting, whose duties it shall be to 
draft new bills and to suggest the necessary amendments to existing 
laws. 

1st. To have a member of the medical profession on the State 
Board of Education who shall also have oversight of the school 
inspectors throughout the State. 

2d. To have regularly appointed school inspectors throughout the 
State whose duties shall be to make a thorough examination of all 
children in the public schools at stated intervals. 

3d. To have introduced into all the public schools a department of 
physical education, in the broadest sense of this term, which depart- 
ment shall be under the supervision of a school inspector. 

This is a matter of vital importance to the community. To 
promote the well-being of society, to give it more fully developed 
men and women, healthy in body, mind and morals is the sole object 
of our profession in this matter. In it we need and, I think, we can 



132 MEDICAL SOCIETY OF NEW JERSEY. 

expect, the hearty co-operation of educators. If by our combined 

efforts we can be the means of accomplishing such legislation, it will 

reflect honor and credit upon the State of New Jersey by making it 

foremost in a reform which is greatly needed, and which sooner or 

later will, in all probability, be effected. 

Joseph Tomlinson, 

David C. English, 

E. L. B. Godfrey, 

R. C. Newton. 

W. B. Johnson, 

Committee, 
DISCUSSION. 

Dr. Savary Pearce. of Philadelphia.— I wish to congratulate you 
on being so active in new matters although such an old society. The 
subject which your committee has presented so well meets with my 
approval, so far as I understand it. It is certainly coming to be 
known, not only by physicians, but by educators, that the growing 
youth of to-day. especially in the cities, are being overwrought. This 
is because in these strenuous times educators are going along in the 
same fashion, and have added a multiplicity of studies to the school 
curriculum. I have been interested in this subject, more particularly 
from the neurological standpoint, and have observed in the past 
decade instances in which the education has at times been the cause 
of many mental diseases in children, and I believe that in the large 
cities no intelligent physician of experience will deny this. This is. 
of course, not so manifest in the smaller places, and hence the child 
of to-day is fortunate who is born in the country or in the smaller 
towns. We must strike at the root of the evil by reaching the 
educators who are striving after too much. As general practitioners, 
we should be able to accomplish a great deal by individual instruction 
and advice in our families. No law can be made that will fit individual 
cases, and hence it is the duty of the family physician to warn the 
parents of precocious children of the danger of allowing these bright 
children to develop too fast mentally. The teachers of such children 
should be warned against urging such children to compete for prizes. 
Parents often make the great mistake of adding to the over-filled 
school course further instruction, such as music and other accom- 
plishments. 

The investigation started by the American Medical Association in 



PROGRESS IN MEDICINE AND THERAPEUTICS. 1 33 

the "Section on Nervous and Mental Diseases," I trust will assist you in 
this very important matter. I believe this Society is the first State 
society to take a step in this direction. It is perfectly possible to 
secure the co-operation of the politicians if we only make them see 
that we are working for the good of the community. It is encourag- 
ing to know that some of the educators in New Jersey are already on 
our side. Many children, it is true, are hereditarily predisposed, but 
how can we get rid of heredity if we do not begin to improve the 
present generation ? It is an admirable suggestion that the physician 
be placed upon the school board, but it is important that he should be 
a broad-minded man of large experience. 

Dr. Rogers, Paterson. — As a person having some experience in 
family practice, I would say that I often urge that the children be 
given fewer studies, but it is said that this cannot be done because it 
is opposed to the regulations of the schools. We may perhaps do 
something by getting the County Societies to recommend to the local 
boards a diminution in the number of studies at the schools. 



Progress in Medicine and Therapeutics. 

BY W. H. IRELAND, M. D., CAMDEN, N. J. 

Progress along the lines suggested to me to report upon at this 
meeting is not only considerable, but in some respects surprising and 
revolutionary. The brief time allotted for the reading of a report of 
this kind precludes anything but an outline mention of the subject. 
It is interesting beyond expression, and it is a pity that the members 
of the profession, most richly endowed by the experience of active 
practice, can least afford the time necessary for its profitable ••n- 
sideration. 

Who of us has not often deplored the lack of time to devote to 
these interesting new developments ? Consider alone the immtnse 
advances made in electro-therapeutics, a division of practice already 
become so specialized as to have a national and many local organiza- 
tions, with physicians of superior ability devoting themselves to it 
exclusively. 

How much does the average practitioner actually know of the gal- 
vanic, faradic, alternating, and static currents ? Still less does he 



134 MEDICAL SOCIETY OF NEW JERSEY. 

know of their effects, and their indications for the alleviation of 
suffering and the cure of disease. How much did they know but 
a few years ago of the anodyne effect of the positive pole, the electro- 
lytic effect of the negative pole, the muscle contracting influence of 
the faradic current from the thick wire coil as compared with the 
pain relieving qualities of that from the fine wire coil, of the benumb- 
ing effects of the alternating current, and the many unsuspected 
effects of static electricity? The cure by electrolytic removal of 
urethral stricture and of tumors are established facts. The cataphoric 
diffusion of drugs, directly into and through diseased structures, has a 
more positive effect than its application with a hypodermic needle, 
and is at the same time devoid of its objectionable features. 

Bouchard {La Tribune Medicale, Jan. 14th, 1903), has shown that 
the direct application of a small portion of a dose locally, by injection, 
is even more efficient than the much larger quantity given by the 
mouth, yV o^ ^^ usual dose by the mouth being sufficient if injected 
directly into the affected part, thus also avoiding the necessity of 
drugging the entire organism simultaneously with one of its parts. 
Catophoresis would serve this purpose even belter, for the medica- 
ment could be distributed evenly and accurately to the affected area, 
without any discomfort, by a mere placing of electrodes of proper 
size. 

To the extraordinary advantage of the X-rays it is only pecessar>' 
to refer, for while they are no better understood by the average 
practitioner than are other electro-therapeutic matters, their effects 
have been so much exploited to satisfy an excusable curiosity, that 
their usual effects may be said to be common knowledge. And the 
capabilities of this new agent is already so great, that the mere enum- 
eration of the many things it is said to be good for in medicine would 
consume hours. Its most decidedly positive usefulness, however, is 
in locating dense or metallic foreign bodies, in outlining the denser 
organs, such as the heart and liver ; by discovering pathologic condi- 
tions by change of density in structure, for instance the apices of the 
lungs in commencing tuberculosis ; and in the destruction of morbid 
processes upon the surface of the body, when properly exposed to its 
influence, ending in cure, among which may be mentioned lupus, rodent 
ulcer, cancer, and even acne, as well as other hitherto intractable sur- 
face conditions. Even aggravated cases of inoperable cancer of the 
uterus, vagina and rectum are claimed to have been cured, or at least 



PROGRESS IN MEDICINE AND THERAPEUTICS. 1 35 

much benefitted, by the use of specially constructed tubes. (Margaret 
A. Cleaves, in the Philadelphia Medical Journal, of April i8th, 

1903-) 

Naturally associated in one's mind with X-ray therapy is the 
rapidly developing treatment of many conditions by means of solar 
and electric light. This is more commonly known as the Finsen light 
treatment, in which, however, our OMoi countryman, Dr. J. W. Kime, 
of Fort Dodge, Iowa, is entitled to a fair share of credit. 

Physicists are now able to tell us that the visible spectrum of seven 
colors marks but a small part of the detectable solar influence after 
prismatic dispersion of the light ray, the strongest heat quality being 
found beyond the red end of the spectrum, and the most pronounced 
chemic effects at, and reaching far beyond, the opposite or violet end. 
Dr. Kime has made pictures upon negative photographic plates by 
means of concentrated solar light filtered through blue glass before 
passing through the body to the plate. He has achieved the same 
result through his own hand. With the daily exposure to the con- 
centrated rays from a larger mirror upon the affected parts of the 
bared chest, he has favorably modified, and probably cured, incipient 
pulmonary tuberculosis. 

One of our brethren in New York has been equally successful in 
laryngeal tuberculosis with the applications of the incandescent elec- 
tric light directly to the throat. 

A solarium is a most valuable annex to every institution for hasten- 
ing convalesence. Sun baths with the body entirely naked have been 
found to be of the greatest value in the successful treatment of most 
conditions. A fact lately brought to light is that the efficacy of iron 
in anemia is enhanced manifold by the liberal exposure of the patient 
to sunlight. But that sunlight is always beneficial would be an 
erroneous, and sometimes unfortunate, conclusion, for this is not al- 
ways so. Thus as was long ago shown, and very lately again main- 
tained, that the germ of malaria only thrives in the light. Attention 
has been called to the uniformity with which malarial attacks occur 
in the day-time, and to their diminished severity in cloudy weather. 
This is now explained by the illumination of the body tissues by sun- 
light, or in a lesser degree by the diffused light from a clouded sky, 
sufficient to meet the needs of the malarial germs. On this account 
it has been suggested that malarial cases should be kept in the dark 
until cured, or at least in a room illuminated with blue light, which 



136 MEDICAL SOCIETY OF NEW JERSEY. 

seems to be deadly, or at least inhibitory, to the germ of the disease, 
as witness the efficacy of metheline blue, and some other remedies 
causing a bluing of t|}e blood in the cure of malaria. 

I may, in passing, refer to the recent increase of pneumonia, both 
in its prevalence and mortality, and this despite the fact that we can 
not treat the disease more successfully than we could not so many 
years ago. Creosote at the rate of one drop per hour, thpugh not 
necessarily given at one hour intervals, has been claimed by many to 
be a specific in this disease, and there is ample evidence adduced to 
justify its being so considered in a certain class of cases that are not 
yet clearly defined. In the same way do we know the salicylates to 
be strikingly efficient at times in this disease, though at other limes 
without any special eflect. 

We have still the advocates of hot applications, and those who favor 
the use of the ice bag in this disease, both claiming satisfactory results, 
which brings back to mind the experiments of the elder Flint, at 
Bellevue. many years ago. in which he divided his pneumonia cases 
during at least a part of one season into two classes, one receiving 
medicinal treatment and the other none, the mortality being the same 
in both groups, thus indicating that medicinal treatment was inconse- 
quential. 

Despite the many claims to the contrary, the sum total of our 
accumulated experience in the treatment of typhoid fever forces the 
inevitable conclusion that we are still without any special remedy in 
this disease. Cold bathing for the reduction of temperature has lately 
again become the vogue, and is, in all probability, detrimental to many 
patients where its routine use is persisted in despite its needlessness. 
Sponging would appear to be adequate in many instances, as has been 
claimed. The therapeutic claims in regard to this affection vary 
between the widest extremes, from those who content themselves 
with the reduction of hyperpyrexia by means of cold bathing or 
sponging, together with such medicinal treatment as may be specially 
called for from time to time, with good nursing, and those who use 
vaunted specifics with which they claim to abort the disease. Some 
would have us believe that they do this with eastor oil, others with 
calomel, still others with belladonna, some again with extremely 
minute doses of the arsenite of copper, or of larger, though still 
minute, doses of the sulphocarbolate of zinc, or the use of other 
mild antiseptics. While I would not attempt to deny the efficacy of 



PROGRESS IN MEDICINE AND THERAPEUTICS. 1 3/ 

any drug, even in the most minute dosage, without adequate experi- 
ence in its use, it seeems to me too much to ask the mind to accept 
an explanation of a claim of cure for typhoid fever by sulphocarbolate 
of zinc in hourly doses of -^ of a grain or ^ hour doses TTriinny grain of 
arsenite of copper, by virturc of their antiseptic properties. There 
are some who stimulate in typhoid fever, and those who do not. 
This disease is one of the common ones that may be said to nearly 
always be with us in the large cities, particularly in some, such as 
Philadelphia, and yet, despite our long and continued experience with 
it, we are no nearer an effectual remedy than we ever were, though 
we have the satisfaction of being able to rate it among the easily pre- 
ventable diseases, inasmuch as we know its cause and mode of 
propagation. It may, therefore, be truly said of typhoid fever, that 
little, if any, real advance has been made in its medicinal treatment. 

This report would hardly fulfill its mission without a reference to 
the magnificent progress made in our knowledge of the cause and 
extension of malaria and yellow fever. Concerning the latter, there 
was the most earnest and satisfactory discussion at the last meeting 
of the American Medical Association, so recently held at New 
Orleans, in which it was quite conclusively shown that yellow fever is 
only transmitted by inoculation from the bite of a variety of mos- 
quito. This insect absorbes the poison with the blood of the sufferer 
afflicted with it, after which the germ of the disease requires twelve 
days for its development in the insect, only after which its bite will 
convey the disease. The great care in treating a yellow fever case, 
therefore, is to screen him from mosquitoes so that he may not be 
bitten by one that will subsequently inoculate someone else. It 
was shown that all attempts to stamp out the disease by cleanliness 
and disinfection were not only unavailing, but had little effect in 
checking the ravages of an epidemic. When, however, the mosquito 
became the object of attack, the disease rapidly lessened, and finally 
Tanished, uatil we have to-day one of the most glorious achievements 
for scientific medicine to point to in the experience with yellow fever 
in the Island of Cuba, and more especially its capitol, Havana. 

The soiled and unwashed bedding used for fatal cases in yellow 
fever were also used by non-immunes sleeping in the same bed, and 
in the identical room, undisinfected for a period of twenty days, without 
showing the slightest evidence of the disease. Yet these same individu- 
als subsequently promptly contracted yellow fever when experiment- 



138 MEDICAL SOCIETY OF NEW JERSEY. 

ally bitten by infected mosquitoes. Thus have we stamped out a 
malignant disease that baffled all our therapeutic efforts by the dis- 
covery of its cause and mode of propagation, making prevention easy, 
an illustration of the old adage that prevention is better than cure. 

Almost as much may be said of malaria regarding its origin and 
extension. In this, quinine has been the well-known sheet anchor for 
more than a century, without its mode of action being, even yet, 
satisfactorily explainable. Its wonderful efficiency is so great as to 
have robbed the disease, in most localities, of its terrors, and yet who 
will deny the incomparably greater advantage accruing from its pre- 
vention and stamping out, made possible by a knowledge of its 
cause } 

Councilman, of Boston, has very recently announced his belief in 
having discovered the essential cause of smallpox, but whether or not 
he is correct remains to be shown. Here again do we have a 
peculiar association of conditions ; a disease without specific remedy, 
leaving its hideous imprints upon most of those fortunate enough to 
escape its ravages with their lives, of unknown cause and means of 
propagation, and yet with a preventive almost absolute and peculiarly 
its own, that nevertheless finds many victims the world over, even in 
the most civilized communities, through reprehensible neglect to take 
advantage of the boon of vaccination. 

The greatest advance, however, in the treatment of disease, is in 
the use of antitoxic serums, and of animal extracts. The most 
notable of the serums, I think it safe to say, is the antitoxin 
of diphtheria. Its efficiency can hardly be any longer ques- 
tioned, though it is not universally acknowledged. Its effectiveness 
in diphtheria has led to much laboratory work, with the 
result of launching many explanations and propositions, probably the 
most prominent among them being Erlich's *' side chain " theory of 
immunity. The serum treatment of disease promises to be increas- 
ingly effective in the future as its applications become better under- 
stood. The essential principle underlying this mode of treatment 
is to inject into an affected individual serum from the blood of an- 
other recovering, or just recovered, from the same disease, and wliich 
is. therefore, antidotal or antitoxic to the germ of that disease. With 
the speculation as to how immunity is developed. I have nothing to 
do, but will only say that it has been demonstrated beyond room for 
reasonable doubt, that the resistance to certain diseases with which 



PROGRESS IN MEDICINE AND THERAPEUTICS. 1 39 

one may already be affected is much increased by the addition to the 
blood of a small quantity of blood serum taken from the circulation 
of another individual just over a similar attack. 

The serum treatment of disease is often, but never should be, con- 
founded with preventive innoculation, such, for instance, as is prac- 
ticed in the Pasteur method in hydrophobia. Here the actual virus of 
the disease is enough attenuated by dilution until a small quantity can 
be thrown into the system without danger to life, though not without 
the production of more or less constitutional disturbance. It is fol- 
lowed by successive doses, each one less attenuated than the proceed- 
ing one, until it may be given in full strength without detriment to the 
individual, though this might, and probably would, have been 
positively fatal if given in the first instance. 

The explanation of this is that the first weak dose slightly stimulates 
the formation of an antitoxin antagonistic to the toxin introduced. 
This in sufficient to neutralize a similar dose if again introduced, 
wherefore, this amount, plus another, can be given the second time 
without greater disturbance than occurred with the first. Thus is 
complete immunity gradually attained in successive stages. The 
whole theory of antitoxic serum treatment is rational, reasonable, and 
full of positive promise for all conditions subject to antagonism by 
the development of antitoxins. 

While upon this subject it may be well to refer to the so-called 
Truneck serum, which, however, is only an imitation of what might 
be called a syntlietic serum, as it is a watery solution of a half-dozen 
of the mineral salts normal to the blood. Truneck's original paper 
appeared in Semaine Medicate, of April. 1901. He devised the 
mixture for the purpose of supplying to those afflicted with artero- 
sclerosis, and its entailed symptoms, the salts of which it is composed 
and of which the blood, in these cases, is very deficient. Dr. Alfred 
Gordon, of Philadelphia, in the Philadelphia Medical Journal, of 
March 21st, 1903, reports a modification of the original serum, which 
he finds as efficient, or even more so, than the original. In a series 
of twelve cases, he reports some remarkably gratifying results follow- 
ing the use of the *' serum." Effects, as a rule, are not clearly evident 
until more than a week's use of the remedy. This experience also 
opens wide the door of possibilities in the successful use of similar 
combinations in hitherto intractable conditions. 

Regarding the remedial effects of animal extracts, as much can be 



I40 MEDICAL SOCIETY OF NEW JERSEY. 

said as for serums, with this .difference, that while the serums add an 
extraneous antagonistic element, the extracts develop such within the 
body by stimulating the proper agencies for their production. This, 
at least, is the explanation of the theory. A mention of these sub- 
stances would be very incomplete without a reference to the claims 
of Dr. Sajous, of Philadelphia, in regard to the so-called *' adrenal 
system.*' This consists of the pituitary body, the adrenals, the 
thyroid, and their nerve connections. The posterior lobe of the 
pituitary controls- the nerve connections and associations of the body, 
while the anterior presides over oxidation and nutrition. The thyroid 
secretion has, as its main constituent, iodine, of course in organic 
combination. This is a great stimulant of the pituitary, in fact the 
greatest known. The pituitary in turn stimulates the adrenals, which 
secrete a substance which Sajous designates " adrenoxin." and which 
has as its main peculiarity the property of attracting oxygen to the 
blood, and of inducing chemic changes in the various cells, causing 
oxidation, nutrition, and the liberation of energy, as well as the 
production of antitoxins, and increasing the germ-killing (phagocytic) 
action of the white blood cells. One of two large volumes in defense 
of this theory has already appeared, and must be said to make out a 
good prima facia claim. 

We know the effects of the extracts of various parts of the body» 
notably those of the thyroid and adrenals, and, reasoning by analogy, 
are fully justified in inferring that every important organ, at least, 
secretes a substance having some pronounced effect upon the organ- 
ism at large. What these are yet remains to be seen. That they 
will afford effectual means to combat disease in the future, is one of 
the fairest of inferences, but as to how soon this desirable advance in 
therapeutics will be consumated is the merest kind of a guess. I need 
hardly mention the effect of adrenal extract upon the heart and circu- 
lation, and of thyroid extract in myxedema and cretinism, as they 
are already well known. 

Dr. G. W. Parry (Lancet, Feb.. 1903) reports hereditary and 
acquired hemophilia absolutely cured with a few months use of 5 
grains of thyroid extract three times daily. In two of these cases 
tke persistent bleeding could not even be arrested by the local use of 
adrenalin chloride. 

It is only fitting that I should make some reference to the ** great 
white plague," consumption. This deadly and inslduous affliction, 



PROGRESS IN LARYNGOLOGY. I4I 

for which there is. as yet. no real specific remedy, has lost much of 
its life-destroying power in recent years because of our better know- 
ledge, our better understanding, of its course of the knowledge that 
nature is herself competent, in most cases, to successfully combat the 
disease if placed under favorable conditions to this end. and main- 
tained there until the patient is well. These are rest, fresh air. and 
forced feeding, together with such additional auxiliaries as will be 
helpful. The outdoor sanatoria under state aid now existing in some 
of our commonwealths, are characteristic of the growing altruism of 
our age. We now have the cheering assurance that the preponder- 
ance of probability is in favor of any case of pulmonary tuberculosis 
getting well if continually kept under favorable conditions. So far as 
the annual saving of life is concerned, this is one of the greatest 
advances made in therapeutics within recent years, the importance of 
which is incalculably augmented from the economic point of view by 
the saving of productive power to the community. 

I desire to say. in closing, that I mainly held myself to outlines and 
general statements in this report because of the extremely limited 
time that could be alloted to the subject, because of the equal right of 
others for like consideration, and the great extent of the field I had to 
cover. I am well aware that I have not mentioned some things, and 
have but inadequately touched upon others, but for such shortcom- 
ings I must again plead the time limit set by our regulations, which 
would prevent the reading of an entire paper of the length this would 
have assumed had I undertaken to give an exhaustive resume. 



Progress in Laryngology 

BY B. A. WADDINGTON, M. D., SALEM, N. J. 

From the standpoint of the general practitioner one of the most 
important recent advances in laryngology is the use of adrenaline 
hydrochloride for the prevention of hemorrhage from the upper 
respiratory tract. Under favorable circumstances practically blood- 
less operations may be done within the nose by spraying the parts, 
previous to the operation, with a i to i ,000 solution of this substance 
and the operation hence greatly facilitated. For example : One of 
the^ chiefs impediments to the speedy removal of a number of nasal 



142 MEDICAL SOCIETY OF NEW JERSEY. 

polypi with a snare is nasal hemorrhage, which after the removal of 
the first polypus coats everything within the interior of the nose with 
blood and renders the polypi indistinguishable from the normal 
structures. By first cocainizing the nasal chambers and then spray- 
ing the polypi with a i to i.ooo solution of adrenaline hydrochloride, 
so little bleeding occurs that the polypi can readily be differentiated 
from each other and the surrounding structures, and lemoved one 
after the other with the utmost facility. Sometimes not more than 
one or two drops of blood will be lost as the result of the removal by 
the snare of six or eight nasal polypi, and should this small amount of 
blood at any stage of the operation obstruct the view, it is readily re- 
moved by means of absorbent cotton. 

For a bloodless operation within the nose the field of operation is 
best prepared in the following manner: pledgets of. absorbent 
cotton are saturated with a 3 per cent, solution of cocaine, which 
with forceps is placed within the nose in contact with the parts to be 
operated upon and allowed to remain at least half an hour. By 
employing a weak solution of cocaine which remains in contact with 
the parts for a considerable time more profound and deeper an- 
aesthesia of the tissues is finally obtained than if stronger solutions 
were used ; because when strong solutions are used the capillaries 
contract and the tissues shrink, after which absorption goes on more 
slowly than if a weaker solution were used. 

After the parts have been anaethetized by cocaine they are sprayed 
with adrenaline solution. This substance is sold by the pharmacists 
in I to 1,000 solution, but is active in the strength of i to 20,000. 
However, for important operations it is best employed in full strength of 
I to 1,000, as it is said to be absolutely non-toxic, and there is no 
danger of poisoning from the use of large quantities. 

As the result of spraying adrenaline solution the intra-nasal tis- 
sues, already blanched and shrunken from the use of the cocaine, are 
still further shrunken and appear more white and bloodless than the 
skin. The capillaries contain so little blood that they may be severed 
without hemorrhage. Large exostoses or ecchrondoces may, some- 
times, be removed by means of the saw with practically no hemorrhage. 
This, however, is not always possible, because adrenaline exerts its 
effect mainly upon the capillaries and has comparatively little effect 
upon the larger vessels ; so that if in sawing through bone or carti- 
lage a compartively larger artery is severed, the artery will bleed and 
spurt practically the same as if no adrenaline had bten used. 



PROGRESS IN LARYNGOLOGY. 1 43 

Adrenaline solutions cannot advantageously be employed to control 
nasal hemorrhage ; because the presence of blood washes away the 
solution when sprayed into the nose and prevents its coming into 
direct contact with bleeding mucous membrane. Nasal hemorrhage 
is probably most readily controlled by the use of peroxide of hydro- 
gen in the manner described by Gleason, of Philadelphia. A piece of 
absorbent cotton is wrapped very loosely about a probe so as to form 
a cone about three inches in length. Its distal extremity is about 
half an inch in diameter and its proximal extremity about an inch and 
a half in diameter, the cotton being wrapped so loosely about the 
probe that it readily can be compressed sufficiently to enter the nasal 
chambers. Such a mass of cotton will take up about half an ounce 
of peroxide, and should be inserted dripping with peroxide into the 
bleeding nostril until its small extremity closes the posterior nares. 
Immediately the blood within the nose clots and the clots swells to 
an enormous size, while much gas escapes from the nostril After 
the insertion of the cone of cotton within the nose, a finger tip of the 
left hand is placed against the cotton to steady it and the probe is 
withdrawn, leaving the cotton in position. If necessary, one, two or 
more pledgets of cotton saturated with peroxide are placed within 
the nostrils to make additionat pressure. Under siich cirumstances 
as this, the blood penetrates the fibers of the cotton, it is clotted by 
the peroxide and the clot quickly becomes large enough to exert 
sufficient pressure to control the hemorrhage. The more severe the 
hemorrhage, the more quickly is it controlled. 

Because solutions of adrenaline blanch and shrink the intra-nasal 
mucus membrane, it was hoped that this substance used locally 
would prove an effective remedy for hay fever. However, this ex- 
pectation has not been fully realized because of the reaction that 
follows its use. The blood vessels becoming more dilated than 
before within an hour or two after its employment. For this reason 
secondary hemorrhages after nasal operations are more common after 
the use of adrenaline than if it were not employed. The substance 
also is distinctly irritating, and if used at all in hay fever, should be 
employed only in dilute solutions i to 20,000, used as a spray or 
placed in contact with the nasal mucus membrane by means of 
absorbent cotton. Used in this way, it oftentimes gives satisfactory 
results without disagreeable after-results. It can be used as often 
as every hour or two. 



144 MEDICAL SOCIETY OF NEW JERSEY. 

However, the most important advances made in the treatment of 
hay fever is that described by Bishop, of Chicag^o, who pointed out 
the connection of hay fever with the uric acid diathesis. Bishop pre- 
pares his patients for the hay fever season by the administration of 
alkalies. If, in spite of his preparatory treatment, an attack occurs, 
he prescribes either dilute sulphuric acid or Horsford's acid phosphate, 
a teaspoonful well diluted after meals and at bed time. 

Gleason, because of the action of nitro-muriatic acid upon the liver, 
advises during the attack 3 to 5 drops of concentrated nitro-muriatic 
acid in a tumbler of water. According to Bishop the attack of hay 
fever is the result of an excess of uric acid in the blood, which irritates 
the mucous membrane of the nose, eyes and trachea. The exhibition 
of an acid renders the blood sufficiently acid to prevent the absorption 
of uric acid. 

Gleason ascribes the attack not only to the presence of urates in 
excess, but notes that the urine of hay fever patients is often loaded 
with crystals of oxalate of lime, and attributes some of the good 
results following the use of nitro-muriatic acid to its preventing the 
formation of this salt. 

Whatever may be said concerning the theories of the causes of 
hay fever, it may often be aborted within forty-eight hours by three 
to five drop doses of concentrated nitro-muriatic acid after meals and 
at bed time in a tumblerful of water. The remedy, however, is only 
effective in a somewhat large proportion of cases, but if successful 
will show its good effects within one or two days. To prove effective 
the acid must be used during the entire hay fever season and the 
patient will feel the bad effects of omitting a single dose of the 
remedy. For example, should the evening dose be omitted, the 
patient will probably have some of the symptoms of hay fever the 
next morning. The acid treatment continued through two or three 
hay fever seasons has. in many instances, resulted in a permanent 
cure. 

Until within the past five or six years, operations for the correc- 
tion of deviations of the nasal septum were notoriously unsuccessful. 
At the present time we have three methods of operation yielding 
almost uniformly successful results—those of Asch, Gleason and 
Kyle. In order to understand these operations, it must be borne in 
mind that the entire nasal septum is never deflected, and therefore, it 
is more proper to speak of a deflected area of the nasal septum. 



PROGRESS IN LARYNGOLOGY. 145 

Asch, by means of special instruments, makes a crucial incision 
through the deflected area of the septum. The four triangular flaps 
are then thoroughly bent beyond the median line, and retained in the 
median line by means of tubes in each nares, which are worn for 
some time ; that in the formerly obstructed nares being worn until 
healing is complete. Gleason makes a saw cut from below, up about 
the entire deviated area and then bends the quadrilateral flap con- 
sisting of the entire deflected area beyond the median line. He 
endeavors to fracture the bone in the neck of his flap, if bone be pres- 
ent, or to so thoroughly bend the cartilage, that its resiliancy is 
destroyed until healing is complete. This can be accomplished in 
rather more than 80 per cent, of the cases, so that no tube of other 
means of support is required during the healing process. Gleason 
claims as the advantages of his methods over that of Asch, that there 
is only one flap to bend and that is so situated that the neck of the 
flap generally contains bone which can be broken, so that the 
resiliancy of the septum is entirely destroyed and there is no tendency 
for the deformity to be reproduced. 

He also states that the larger proportion of cases of septal devia- 
tion are the result of traumatism and that his U-shaped saw cut 
practically reproduces the original traumatism, so that it is really 
the same as if one were setting a recent dislocation or frac- 
ture of the anterior part of the septum. The Asch operation is done 
under ether narcosis, that of Gleason under cocaine anaesthesia. 
Both operations are popular both in America and in Europe. 

Recently Kyle, of Philadelphia, has devised an operation which 
consists in the removal of wedge-shaped masses from the deflected 
area by means of a special instrument devised by Fiterof, resembling 
a short, three-cornered flle. An incision by means of this instrument 
is made below the deflected area upon the concave side of the septum. 
Two similar cuts are made through the deflected area upon the con- 
vex side of the septum. It will be seen that as the result of the 
triangular shape of these parallel incisions, that when the septum is 
brought into the median line, that redundancy of the septum has 
been removed, and that the triangular cuts become simple, straight 
incisions. Kyle modifies his method of operation when the nose is 
twisted to one side, by making an incision through the skin of the 
bulge of the nose sufliciently large to enable him to introduce 
Fiterof's flle into the nares, so that a perpendicular wedge of bone 



146 MEDICAL SOCIETY OF NEW JERSEY. 

and cartilage can be filed out of the septum at its convexity. When 
the nose is turned into the median line of the face, this V-shaped in- 
cision is brought together. During the healing process the parts 
are retained in position by means of a tube worn within the nose. 



Report on Progress of Surgery. 

BY CHARLES YOUNG, M. D., NEWARK, N. J. 

It has seemed best to occupy the limited time allotted to this report 
in considering some of the questions of surgery at present subjudice. 
We will confine ourselves in the main to abdominal surgery. 

Let us first direct our attention to the gall-bladder. 

So long as nothing prevents this organ from emptying its contents 
it is almost certain to remain normal, but if an obstruction occurs, 
trouble is likely to ensue. Interference with drainage is sure to cause 
an accumulation of a certain amount of residual substance, in 
which large numbers of bacteria may collect, with resulting injury to 
the lining of the organ, at first, perhaps, simply catarrhal, but which 
later may become destructive to the mucous membrane, giving rise to 
ulceration, which may in turn result in cicatricial contraction and 
further obstruction. Bacterial infection conduces to the formation of 
gall-stones. These become additional sources of irritation with their 
irregular forms and sharp angles and projections. This is the theory 
promulgated by Albert J. Ochsner, M. D., of Chicago, in an article 
in Annals of Surgery, June, 1902. "Bacteria, especially the colon 
bacillus, are present with great regularity in diseased gall-bladders 
and in gall-stones." '* Gushing has found that 30 per cent, of the gall- 
stone patients operated on at Johns Hospital had previously suffered 
from typhoid fever, and Ochsner has found that more than 35 per 
cent, of his cases suffered from acute or chronic appendicitis. The 
sequence of the infection is difficult to determine." The causes of 
obstruction may be various. From an analysis of forty-eight cases 
operated on in 1901, Ochsner directs attention (i) to the sex qf the 
patients, th«re being 37 women and 11 men in the table; (2) to the 
age, only one of the patients being less than thirty years old at time 
of admission ; 37 of the 48 complained especially of gastric disturb- 
ances and had been treated by a number of physicians for gastritis ; 
(4) one-half of these patients had never suffered from distinct biliary 



REPORT ON PROGRESS OF SURGERY. I47 

colic ; (5) only a small proportion (25 per cent.) had ever been severely 
jaundiced at any time; in 25 cases no jaundice had ever been 
observed. Gall-stones were absent from the feces of all but a few 
cases. In diagnosis, then, Ochsner relies rather on (i) digestive 
disturbances, a feeling of weight or burning in the vicinity of the 
stomach after eating, gaseous distension of the abdomen ; (2) a dull 
pain extending to the right from the epigastric region around the 
right side about at a level of the tenth rib, extending to a point near 
the spine and progressing upward under the right shoulder blade ; 
(3) a point of tenderness upon pressure between the ninth costal 
cartilage of the right side and the umbilicus ; (4) a history of having 
had one or more attacks of typhoid fever or appendicitis ; (5) in 
many of these cases there is a slight yellow tinge of the skin ; (6) there 
is usually a slight increase in the area of liver dullness ; (7) there may 
be a swelling of variable size opposite the end of the ninth rib. If 
we have added to these symptoms the biliary colic, followed by 
distinct jaundice, and possibly by the passage of gall-stones, our 
diagnosis is further confirmed. The danger of operating is not 
approximately the same before and after the occurrence of compli- 
cations. The scries of operations shows that all cases recovered if 
operated on previous to the occurrence of complications. Mayo 
Robson, in his excellent work on this subject, gives a list of twenty- 
eight complications which may follow or accompany the presence of 
gall-stones. Ochsner lays down the principle that unless the acute 
condition is complicated with a mechanical obstruction of the 
intestines, the patient's chances for recovery from the acute attack are 
always better without than with an immediate operation. It is 
necessary to make a definite distinction between intestinal obstruc- 
tion due to peritonitis and the same condition due to a mechanical 
condition, such as the impaction of a gall-stone. The former condi- 
tion is so much more common than the latter that it is only very 
seldom that the latter need be considered. 

To the Anna /s of Surgery, June, 1902, William J. Mayo, M. D., 
Rochester, Minn., contributes an article presenting an analysis of 328 
operations upon the gall-bladder and bile passages. The operations 
were done at St. Mary's Hospital, Rochester, between June 24, 1891, 
and February 28, 1902. Three hundred and eleven were of benign 
origin, and the number of deaths was eight, about 2| per cent. 
Seventeen were for malignant disease, with three deaths, a mortality 



148 MEDICAL SOCIETY OF NEW JERSEY. 

of nearly 1 8 per cent. The after-history of many of the cases leads 
to the belief that for cases in which the cystic duct has been obstructed 
or in which stones have been lodged in the duct for a length of time, 
cholecystotomy is insufficient, and that the gall-bladder should be 
extirpated at the primary operation if the patient is otherwise in good 
condition. In thirteen cases stones were found outside of the gall- 
bladder and biliary ducts There were no deaths. In some cases the 
calculi were encapsulated in the adjacent liver border, forming hard 
nodules, which were enucleated by incision. In others, a mass about 
the fundus would contain a number of stones with, perhaps, some 
muco-purulent fluid. Further dissection towards the cystic duct 
would open a fluctuating organ of small size, with every evidence that 
it was but the remains of the gall-bladder. In some cases the 
gall-bladder is perforated, the extruded stones in a mass of adhesions 
communicating freely with the fundus, or perhaps with several such 
pockets lined with granulation tissue and more or less separated from 
•ach other. Stones were found lying in a pocket outside the gall- 
bladder, with adhesions to the intestines but communicating with 
neither : the fundus contracted to a mass of scar tissue. In three 
cases stones were found outside of gall-bladder, with no communi- 
cation with it, but with a fistulous opening into the intestine, twice to 
the duodenum and once to the colon. Mayo says that *' a study of 
these cases leads to the belief that stones passing by ulceration and 
perforation from the gall-bladder and cystic duct to the intestines do 
so slowly, and often, if not usually, cicatrization takes place behind 
before the extrusion into the intestine is accomplished." The next 
most common direction for gall-stones to travel is towards the surface 
of the body. Of cholecystitis there were 34 cases with 3 deaths. 
This mortality shows the serious nature of the infections. The' cases 
may fairly be divided into suppurative and catarrhal cholecystitis. In 
the catarrhal variety cholangeitis was more frequently an accompani- 
ment, although usually of a mild and irregular type, and after the 
operation in three cases there was an extension of inflammation and 
death resulted. In the suppurative form the gall-bladder was com- 
parable to a closed cavity containing pus, and so thoroughly blocked 
at the cystic duct as to prevent progressive infection. Two cases of 
acute empyema, in which the stone was removed after great difficulty, 
developed a fatal suppurative cholangeitis after cholecystostomy. 
One of these cases also had a profound jaundice with purpura hem- 



REPORT ON PROGRESS OF SURGERY. I49 

orrhagica. In the other cases the removal of the impacted stone 
allowed the septic material to penetrate the ducts. In the four cases 
in which the gall-bladder was drained, and on account of the serious 
condition of the patient, no attempt was made to remove the obstruc- 
tion, each one tecovered promptly, and the stone was removed at a 
secondary operation with the gall-bladder. The danger in these cases 
is in progressive infection of the ducts. In acute infections, little 
manipulation should be made and quick drainage established. "Unless 
it is necessary to remove the gall-bladder, it is not wise to break up 
adhesions beyond a point necessary to explore the ducts and manipu- 
late the fundus. They are valuable barriers to the extension of the 
inflammatory process and infection." Jaundice in connection with 
stones in the common duct was a most variable feature. In many 
cases it was so slight as not to attract especial attention, and the 
finding of stones in the common duct was a surprise. In the majority 
the jaundice was marked. Courvoisier long ago called attention to 
the fact that jaundice from stone in the common duct was accom- 
panied by a contracted gall-bladder, which could not be palpated 
externally in 80 per cent, of the cases. This was true in all but three 
of Mayo's cases. In these three the gall-bladder was filled with 
stones, preventing the usual contraction. In three cases capillary 
oozing was a most serious post-operative complication. One case 
was in a precarious condition for twelve days from this cause. 
Robson has called attention to the value of calcium chloride as a 
prophylactic. Mayo had no deaths from hemorrhage after using it. 
Three cases of Jaundice from malignant disease died from post-oper- 
ative capillary oozing. In all of these cases there were sub-cutaneous 
ecchymotic spots, looking like purpura hemorrhagica. No case in 
which this condition was not present died from this cause. Of the 
eight deaths in the benign cases, four were due to progressive infection 
of the twin ducts, with kidney complications, one from the same 
cause with capillary hemorrhage, and one sudden death due to 
myocarditis. Two cases died suddenly on the fourth day. The 
symptoms after the operation consisted of a peculiar nervous unrest, 
pulse 110 to 120, temperature 100** to 102^, gastro-intestinal disturb- 
ance not marked, but some tympanitic distension shortly before 
death, which took place unexpectedly. Post-mortem did not show 
adequate cause for the result. The condition seems to correspond 
with that described as hepatargia, and due to cessation of liver action. 



I50 MEDICAL SOCIETY OF NEW JERSEY. 

The cases belong to the group of cholecystitis without stones. In not 
a single case was peritonitis the cause of death. In a paper published 
in the British Medical Journal, January 24, 1903, B. G. A. Moynihan, 
M. D., F, R. C. S., discusses cholecystectomy. Removal of the gall- 
bladder was first performed on July 15, 1882, by Langenbuch. It is 
an operation comparatively rare in the surgery of the bile passages. 
It is called for in the following conditions: (i) In injuries of the gall- 
bladder, rupture, stab or bullet wounds ; (2) in gangrene of the 
gall-bladder ; (3) in phlegmonous cholecystitis ; (4) in membranous 
cholecystitis ; (5) in chronic cholecystitis with dense thickening of the 
walls of the gall-bladder and cystic duct, with or without stenosis of 
the cystic duct, and in chronic cholecystitis, when the gall-bladder is 
shriveled and puckered and universally adherent. In such cases it is 
no longer a receptacle of the bile; (6) in distension of the gall- 
bladder, hydrops or empyema, due to blockage of the cystic duct by 
calculus, stricture, growth or external inflammatory deposits ; or in case 
of mucous fistula following operations for these conditions ; (7) in 
cases of fistula between the gall-bladder or the cystic duct on the one 
hand and the stomach, duodenum or colon on the other : (8) in 
multiple ulcerations of the gall-bladder or the cystic duct, when gall- 
stones have eroded their way through the walls into the liver, the 
duodenum or other protective adherent masses ; (9) in primary 
carcinoma of the gall-bladder. In all these conditions the removal of 
tbe gall-bladder is either imperative or desirable. Kehr, whose 
experience of the surgery of gall-stones is unrivalled, has recom- 
mended, as a routine measure of the treatment of cholelithiasis the 
removal of the gall-bladder and the drainage of the hepatic duct. 
The recurrence of gall-stones in his patients lessens with the increas- 
ing experience of the operator, and is best guarded against by a 
complete exploration of the ducts in all operations. If this be done, 
the surgeon will occasionally find a stone or stones in the hepatic, 
or common duct, and when no symptoms have been elicited by their 
presence there. The complete and minute examination of all the 
ducts is quite easily performed, if the ordinary vertical incision be 
prolonged upward along the costal margin, and the liver rotated 
by a gentle traction in a forward and upward direction upon the gall- 
bladder. In cases of recent acute or sub-acute cholecystitis due to 
blockage of the cystic duct by a large stone, removal of the gall- 
bladder is certainly not necessary. The gall-bladder should never 



REPORT ON PROGRESS OF SURGERY. 151 

be removed unless the surgeon is convinced that the common duct 
is patent. Mayo, of Rochester, Minnesota, has suggested a modifi- 
cation of cholecystectomy, which has met with some favor. It is 
performed in cases of permanent obstruction of the cystic duct ; the 
common duct being permeable, and consists in the removal of the 
entire mucous membrane of the gall-bladder. The mucous membrane 
at the fundus is separated with some difficulty, but at, and near the 
neck it strips away readily. After its removal, the other coats are 
stitched to the upper angle of the wound. The chief advantage 
claimed for this operation is, that it is more readily performed and is, 
therefore, a less serious procedure. 

In an article on surgery of the gall-bladder in The Journal of the 
American Medical Association, January 24th. 1903, Alexander Hugh 
Ferguson, M. D., of Chicago, speaks of the symptoms of cholecystitis, 
and says : "the most characteristic evidences of the disease are 
manifested by suffering and jaundice with their associated symptoms 
and signs. The sudden onset of regional pains and tenderness, with 
or without apparent provocation, lasting from a few minutes to 
several hours with little or no pyrexia and normal or slow pulse : the 
pain and tenderness stubborn, unyielding to applications of moist 
heat or internal medication and subsiding as suddenly as they 
began, is a clinical picture of a stone, or stones, becoming impacted 
in the cystic duct and again receding into the gall-bladder*' The 
positive sense of the pain is undoubted by the patient and the higher 
sensibility in the gall-bladder guarded by a tense right rectus muscle, 
is easily demonstrated by the surgeon. The pain is sudden in its 
onset ; its seat is sometimes far distant from the gall-bladder ; it may 
follow some exertion wlych increases intra-abdominal pressure. 
But when the surgeon makes pressure over the gall-bladder during 
an attack of colic, it always elicits local tenderness and increases the 
intensity of the local and referred pain. Should the pain continue 
and jaundice ensue, the stone is evidently obstructing the main duct. 

In sixteen of Ferguson's cases, there was no clinical history of gall- 
stones except gastro-intestinal disturbances. Twelve of these had 
dropsy of the gall-bladder, and the stone or stones in each were 
very large and latent, producing no pain. Mr. Jordan Lloyd has 
tersely described the value of giving a prod over the gall-bladder with 
the closed fist. If gall-stones are present, considerable pain may be 
caused. By auscultating over the gall-bladder, the friction sound of 



152 MEDICAL SOCIETY OF NEW JERSEY. 

local peritonitis and perihepatitis is detected. " During the acme 
of colic the gall-stones may occasionally be heard striking against 
each other. " Ferguson has distinctly heard it. Examination of 
the blood for leucocytosis is sometimes helpful. Waiting for the 
attack of colic to pass off proved fatal in two cases that came under 
the observation of Dr. Ferguson. Dr. Ferguson says : " If infection 
is present, the sooner the gall-bladder is attacked and drained the 
better. " •• Early operation shortens suffering, prevents com- 
plications and obstructions of the ducts." "No case should 
be allowed to become chronic. " " Early gall-bladder surgery 
is safe and easy, while late operations are dangerous and 
difficult. " *• The physician has no assurance from clinical exper- 
iences or pathologic findings, that in a given case the attack 
will • subside without causing : {a) jaundice by obstruction of 
the common duct, which may remain until relieved by a serious 
operation ; (d) rupture of the gall-bladder ; (c) ulceration and per- 
foration by pressure of the stones ; (^) death by the severity of the 
colic ; (e) empyema, and (/) acute phlegmonous inflammation, and 
(^) gangrene. " During operation a probe is unreliable for detecting 
the patency of the ducts. The patency may be proved by forcing 
water through them. Dr. Van Hook first employed air for testing 
the patency of the ducts. Air is always available medically pure, 
and quickly balloons the duodenum. It is the quickest and most 
satisfactory test. Any rubber bulb that holds 4 or 6 ounces may be 
employed. 

In the discussion that followed the reading of this paper, Dr. W. 
J. Mayo, Rochester, Minnesota said : '• That in his experience, by 
cutting the gall-bladder loose from the liver, it can usually be drawn 
out of the wound, exposing the ducts. This allows the liver to re- 
cede and gives more room. As to adhesions, I would warn against 
their extensive division in acute infections if they are not giving 
trouble, as they are a good barrier to the extension of the infection. 
Drainage of the hepatic duct is very important. " Dr. James E. 
Moore, Minneapolis, said : " In diagnosis, local tenderness is a prom- 
inent feature. Robson pays great attention to this point, and the 
Mayo-Robson point should be as familiar to us as the McBurney 
point. " Dr. Robert F. Weir, New York, advocated the placing of 
a small pellet of methylene blue in the gall-bladder just before 
the drainage tube has been put in .position. If the tube is patent, 
it will escape promptly into the intestines and color the feces. 



REPORT ON PROGRESS OF SURGERY. 153 

Six cases of general peritoneal infection are noticed because of the 
opinion prevailing among the profession that practically all such cases 
terminate fatally. J. B. Murphy, M. D.. Chicago, reports them in a 
paper in \\i^ Journal of the American Medical Association, April 11. 
1903. He asks. " What are the conditions which produce the fatal 
result?" 2. "Can these conditions be overcome by medical or 
surgical treatment, and, if so, when and how?" The result of a 
general peritoneal infection depends on the following : {a) The type 
of infection. If it be a virulent streptococcus type, with little pus 
formation, the peritoneum is rapidly denuded of the epithelial cover- 
ing and becomes a blistered surface, through which absorption rapidly 
takes place. Death is caused by the large quantity of the products of 
infection rapidly absorbed. If the poison be diluted, or the pressure 
under which the infective products are retained be reduced, the patient 
may pass over the critical period to a convalesence. If it be a 
staphylococcus or a colon bacillus infection, the denudation of the 
peritoneum is slower, the danger of immediate overpowering of the 
patient by the absorbed toxins is diminished and the fatal termination 
is postponed often to four or six days, until such time as the 
fibrinous exudate which covers the peritoneum is exfoliated, taking 
with it the peritoneal endothelia. A rapid and fatal absorption may 
then ensue, ijf) The period of time that elapses between the infec- 
tion and the time of operation. If this is postponed until patient is 
in collapse, the case will terminate fatally. If it be performed in 
the early stage, the peritoneal shingles or endothelia will be found 
intact, thus preventing absorption. When these natural barriers to 
absorbtion are destroyed, as is the case when operation is delayed, a 
fatal termination cannot be obviated, {c) The tension under which 
the products of infection are retained in the peritoneal cavity. The 
mere presence of pus does not necessarily mean absorption of the 
infective products. The greater the pressure under which the pus is 
held in these acute conditions the more rapid the absorption. Reduc- 
tion of pressure is one of the basic principles of treatment of general 
suppurative peritonitis. We believe that irrigation is not necessary 
in the peritoneal cavity any more than it is necessary in circumscribed 
suppurations of other tissues, {d) The diffusion of infective 
material through the peritoneal cavity. It is well known that when 
diffusion takes place in the upper half of the peritoneal cavity the 
danger is enormously increased, because absorption from this part is 



154 MEDICAL SOCIETY OF NEW JERSEY. 

much more rapid than from the lower or pelvic portion. Hence 
patients were kept in the semi-sitting position, at an angle of 35^, 
from the time they came under observation, both before and after the 
operation, until the pus was entirely removed. In all cases an effort 
was made to allow the pus to settle into the pelvis, where it could be 
free from pressure and could be easily carried off by the drainage 
tubes. Absorption took place slowly, and the patients were saved 
from the primary, overwhelming dose of toxins, which is so fatal. 
{e) The administration of antitoxins and other substances to anti- 
dote or dilute the immediate depressing effects of the poisons absorbed 
from the peritoneum. Antistreptococcus serum and unguentum 
Crede were administered, and saline transfusions were given occa- 
sionally. (/) The length of time the patient is kept under the 
ancBsthetic, and the extent of the manipulations of the intestines and 
other tissues to which the patient is subjected during the operation. 
Case I. — The patient was in third week of a well-defined attack of 
typhoid fever. At 3 P. M. on day of admission to the hospital he 
had sudden, severe, sharp pain in region of umbilicus. Pain soon be- 
came general over lower abdomen. In conveying patient from house to 
hospital he was kept in a semi-sitting posture, and this position was 
maintained on the table during the operation. At 10 P. M. abdomen 
was opened. Incision through right rectus. As soon as peritoneum 
was incised a large quantity of yellowish green fluid containing flakes 
of lymph welled out of the opening. The fluid was free in the 
peritoneal cavity, and there were no adhesions. Entire peritoneal 
surface was deeply congested and covered in places with patches of 
exudate. The lustre and gloss of the membrane were preserved. 
Twelve inches from the caecal valve a perforation was found in the 
ileum 4. 5. M. M. in diameter, through which contents of ileum were 
escaping. Perforation was closed and incision closed in separate 
layers. Fluid was not sponged out. Two rubber drainage tubes 
one-half inch in diameter were inserted deep into pelvis, and came 
out through lower end of incision. Through these tubes the pelvis 
was irrigated with normal saline solution, and a large quantity of 
greenish fluid escaped. Patient was returned to his room at 10:40 
P. M. and placed in bed in a semi-sitting posture at an angle of 40®. 
This position was maintained for ten days. The patient was 
discharged with wound almost entirely enclosed December 12, 
twenty-tlve days after admission. 



REPORT ON PROGRESS OF SURGERY. 1 55 

Case 2.— This was one oi perforative peritonitis of three days 
duration on admission to hospital. Operation — Abdomen opened by 
ordinary appendiceal incision at outer edge of right rectus. When 
peritoneum was opened pus and gas shot out, so great was the 
tension. Appendix was gangrenous and perforated. It was removed 
and large drainage tube was inserted into pelvis and right iliac fossa. 
No abdominal sponging or irrigation was used. There was no 
attempt on the part of the intestines or omentum to wall off the 
infective process. The bowel retained some of the natural gloss, but 
the pus was very offensive and the case did not look promising. 
Abdomen was closed down to drainage tubes. Patient was placed in 
bed in the semi-sitting posture. Repeated saline enemata were 
administered and large quantities of fluid given by the mouth imme- 
diately after the patient regained consciousness. Recovery was 
uninterrupted. 

Case J. — Patient was taken ill suddenly on October 9. 1902. Dr. 
Murphy saw her October 12, and concurred in advising immediate 
removal to hospital. Eighty-four hours after onset abdomen was 
opened. Pus welled out. There were absolutely no adhesions any- 
where in the peritoneal cavity. No fibrous exudate on intestines ; no 
effort at agglutination. Appendix was amputated, abdomen closed, 
large drainage tubes inserted; no irrigation or sponging of pus. 
Peritoneum showed considerable congestion, but normal gloss was 
retained. Patient was put to bed in semi-sitting posture at angle of 
35*^. With each inspiration pus welled out of the tubes from the 
pelvis. October 17, discharge profuse and quite offensive. Patient 
was discharged November 23 with wound almost healed. 

Case 4. — Patient's illness began October 18, 1902. Operation 
performed October 21. On incising peritoneum pus welled out and 
was found to be free in peritoneal cavity ; no adhesions except imme- 
diately around the appendix ; peritoneum intensely congested and 
covered in places with fibrinous exudate. The gloss was preserved 
except in certain areas where congestion was most intense. Appendix 
was gangrenous and perforated on one side into the free peritoneal 
cavity. A large fecal concretion was found free. Appendix was 
amputated and stump buried. Two drainage tubes were inserted, 
''one into pelvis, the other into right iliac fossa. No sponging nor 
irrigation used. Abdomen closed in separate layers. Patient was 
placed in bed in semi-sitting posture. Patient made an uninterrupted 
recovery. 



156 MEDICAL SOCIETY OF NEW JERSEY. 

Case 5. — Trouble of four days duration. When admitted to the 
hospital abdomen was moderately distended and extremely tender all 
over. Breathing was almost entirely costal, and the abdominal 
muscles held so rigidly that deep palpation was impossible. On 
piano percussion there was dullness extending almost to umbilicus. 
Absence of peristalsis all over abdomen. On opening the abdomen 
it was found to contain a large quantity of yellowish pus, possessing 
a slight odor. Appendix was gangrenous and perforated. The 
intestines were everywhere bathed in pus, but, though considerably 
congested, they everywhere retained their endothelial covering. 
Appendix was removed. Pus was not sponged out nor abdomen 
flushed. Time of operation twenty minutes. Patient was placed in 
bed in semi-sitting position. Patient made a perfect recovery. 

Cased. — One month previous to present attack, patient had an 
attack of appendicitis lasting four days, and apparently completely 
recovered. He worked steadily until time of present attack, which 
began at 3 A. M. He was awakened by sharp pain in abdomen 
and vomited. He had no chill. Temperature was not above 100®. 
In the morning he walked to the hospital accompanied by his attend- 
ing physician. Pain was still severe and abdominal muscles rigid, 
especially on right side. Tenderness to pressure over abdomen was 
general, but not very acute. A diagnosis of acute appendicitis with- 
out perforation was made, and he was immediately prepared for 
operation. To the surprise of the surgeon the abdominal cavity was 
found to be full of pus, with some gas. There was a perforation of 
the appendix. The perforation had been capped with omentum, but 
the cap had been partially torn off and the contents escaped into the 
peritoneal cavity. Peritoneum was not blistered and gloss was not 
seriously disturbed. The lower half of abdominal and pelvic cavities 
contained large quantities of pus. Appendix was amputated, two 
large drainage tubes were inserted into pelvis. With each inspiration 
pus welled out of the tubes. Patient was placed in bed in semi-sitting 
position. Patient left hospital cured in twenty-nine days from time 
of admission. 

At a meeting of the New York Surgical Society held January 14, 
1903, Howard Lilienthal, M. D., presented a patient whose history 
was that for several years she had suffered from diarrhoea accom- 
panied by hemorrhages and passage of foul mucus from the bowels. 
She finally became so weak and anaemic that another surgeon had 



REPORT ON PROGRESS OF SURGERY. 1 57 

done a left-inguinal colostomy for the purpose of giving a rest to the 
lower colon and rectum. Operation had revealed the fact that the 
walls of the bowel were covered with polypoid growths, which bled 
easily even on gentle manipulation. Patient was much benefited by 
the operation, and it was finally thought best to close the artificial 
anus. As soon as she left the hospital the old trouble returned. 
She- had as many as twelve stools daily, much abdominal pain and 
vomiting. Dr. Lilienthal then opened the caput coli in order to give 
colon as much rest as possible. Colon throughout its whole length 
was found filled with polypoid masses. Examination of them 
showed them to be hypertrophied solitary follicles. Irrigations and 
injections were tried, but did not relieve the condition. Exclusion 
of entire colon from the alimentary tract promised the greatest relief 
with least degree of risk. Consequently an end to end ileo-sigmoid- 
ostomy was performed. Following this the patient's condition 
rapidly improved, but she insisted on having the colostomy wound 
closed, for it still discharged. This necessitated the entire extirpation 
of the colon and stump of the ileum. This was done in June, 1900, 
and since then the woman has been perfectly well. Immediately 
following the operation she had a number of liquid movements daily, 
but the number gradually diminished, and now she usually has two 
daily. The entire colon was extirpated with the upper part of the 
sigmoid figure, and four inches of the ileum. 

At the same meeting Dr. Robert H. M. Dawbarn presented a 
patient under treatment for amoebic dysentery. Following Dr. Weir's 
suggestion he had opened the appendix, which fortunately proved to 
be large and was irrigating the large intestines. A i to 10,000 solu- 
tion of permanganate of potash (ten pints) was given, alternating 
every six hours with the same quantity of normal salt solution at 
a temperature of 120 degrees F. So far the result is highly satis- 
factory. The soreness has practically disappeared, and the amoebic 
character of the discharge was wholly at an end. Dr. F. Kammerer 
emphasized the importance of putting the bowel completely at rest in 
the treatment of these obstinate cases of colitis. He thought the 
result not as good if the feces were allowed to travel through the 
colon. He referred to a case which he showed at a recent meeting of 
the Society, in which he had established an artificial anus, with spur- 
formation for about three months. In the Annals of Surgery, May 
1903, Mayo Robson reports a case of ruptured crucial ligaments of 



158 MEDICAL SOCIETY OF NEW JERSEY. 

the knee, repaired by operation. A miner, who received an injury 
thirty-six weeks before, was admitted November, 1895, to the General 
Infirmary, Leeds, on account of lameness from weakness and in- 
stability of right knee. Knee was swollen, but free from tenderness 
on manipulation. Head of tibia could be brought forward in front of 
femur, and there was very free lateral movement of head of tibia on 
the femur, motion backward being limited only by ligamentum 
patellae. Some fluid in the joint. Operation : Incision starting over 
most prominent part of internal condyle, down and out, crossed liga- 
mentum, patellae about the middle and extended up to prominence of 
external condyle. Both ligaments (crucial) were found torn from 
their upper attachments. They were stitched by catgut ligatures, the 
anterior to the synovial membrane and tissues on the inner side of 
the external condyle, and the posterior which was too short, and was 
split in order to lengthen it, was fixed by sutures to the synovial 
membrane and cartilage on the outer side of the inner condyle. 
Wound was closed ; no drainage; some pain and effusion followed 
operation. Plaster of Paris was applied after stitches were removed. 
October, 1901, the leg was perfectly strong. He walks without a 
limp and can run. He works daily at mining. There is no abnormal 
mobility. Extension is normal, but flexion limited to a right angle. 
On extension and flexion fine creaking is felt in the joint. '* Since 
reporting abov« case, adds Mr. Robson, I find another case was 
operated on August 5, 1898; in 1900 the result was quite satisfac- 
tory." The editor of the ** Annals " says in a foot note, ** Mr. 
William H. Battle, in the British Medical Journal, December 15, 
1902, refers to Vol. XXXI H of the Transactions of the Clinical 
Society of London, p. 232, where is described a suture of the crucial 
ligaments as a part of the procedure adopted in the treatment of 
an irreducible traumatic dislocation of the knee-joint in which an 
open section was made. This was done August 5, 1898. The result 
was good. 

Annals of Surgery, May, 1903, p. 709. A case of an end-to- 
end anastomosis of the Popliteal Artery for gunshot injury. 
On October 20, 1902, E. R. W., 38. was received into Chicago 
Hospital, having been shot in each thigh four hours previously. 
Whole right limb was swollen ; y/i inches larger above patella and 
from I to 2;^ inches around calf and thigh than opposite leg ; swelling 
was increasing. Pallor of foot, but color around knee darker than 



REPORT ON PROGRESS OF SURGERY. 1 59 

normal. Superficial veins engorged. There was loss .of function, 
loss of sensation and motion of foot. Foot and leg felt cold, but he 
said they felt hot and numb. Pressure on any part of leg caused him 
to complain of pain. It hurt him to have limb moved. There was 
diffuse pulsation in popliteal space, seen and felt. A systolic bruit was 
heard behind the knee and a thrill was felt. The track of the 
bullet was cut into, and the femur found to have been penetrated at 
its inner edge about 2 inches above patella. Tourniquet was applied 
to thigh. Long incision exposed popliteal artery along its whole 
length. Liquid and coagulated blood was removed. The artery 
was found to be completely severed at the junction of upper 
and middle third, except a few shreds of the outer coat next the 
vein. The operator, Alexander Hugh Ferguson, M. D., tied slips of 
gauze above and below the injury of artery and removed tourni- 
quet. Lacerated ends of vessel were removed. Anastomosis by 
invagination was then carried out. Upper end was introduced into 
the lower, a distance of a quarter of an inch, and held there by four 
retention sutures of fine silk, and the free end of the lower end sewed 
around the upper with a fine continuous suture. Temporary liga- 
tures were then removed. Pulsation at the ankle was restored at 
once. Pallor disappeared and foot became warm. A broad flap an 
inch wide from the semi-membranosus muscle was lapped around 
artery at seat of union. The next day sensation had returned in 
limb. Forty-one hours after operation a sudden, severe, throbbing 
pain was felt in calf. Foot suddenly changed color and sensation dis- 
appeared. When Dr. Ferguson saw him five hours after, pulsation 
in the anterior tibial artery was gone. Dry gangrene ensued. On the 
ninth day a clear line of demarcation was evident ; the toes, a strip 
down the sole of the foot, and a patch on the heel the size of a silver 
dollar, were dead. On the 31st day the toes, the ends of the meta- 
tarsal bones, a broad strip along the sole and the necrosed patch in 
the heel were removed. This proving unsuccessful, on the 51st day 
the foot was removed at the mediotarsal joint. The patient is now 
well, using his foot and attending to business. In February he com- 
plained of inability to straighten limb. The entire scar tissue was 
dissected out. The artery was examined. Pulsation was seen and 
felt above and below as well as at the site of the anastomosis. In 
looking over the literature, Dr. Ferguson has failed to find a report of 
a similar case. To the New York MedtcOi Journal, ]\ix\t 6, 1903, 



l6o MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Geo, M. Edebohh contributes a paper on Renal Decapsulation 
for Puerperal Eclampsia. The object is to present renal decapsula- 
tion as a further resource in the treatment of puerperal eclampsia of 
renal origin. The renal origin of the eclampsia is insisted upon as 
decapsulation is manifestly out of place if evidence of kidney involve- 
ment is absent. History of case is, briefly: primipara, twenty- 
three, symptoms of nephritis first noted during seventh month, urasmia 
and convulsive seizures during the eighth month ; near the end five 
severe convulsions within sixteen hours, followed by forced delivery 
during fifth seizure. Freedom from convulsions for forty hours 
after delivery, then return of convulsions. Six severe convulsions 
and several minor ones occurring in eighteen hours. Decapsu- 
lation of both kindeys was performed in twenty-three minutes under 
chloroform. There was no tension of capsules, but both kidneys in 
acute and subacute inflammatory condition. Capsules were easily 
separated and cut away close to renal pelvis. No further convulsions, 
and in two days patient, though weak, was in normal mental condi- 
tion. Recovery was uninterrupted. She has since enjoyed as good 
health as ever. Eleven days after operation urine showed a few casts 
and -^ji of I per cent, albumen. A month later there was only a trace 
of albumen and an occasional hyaline cast. Eleven weeks after oper- 
ation urine was normal. 

Renal Decapsulation, — In the Medical Record, March 28, 1903, 
Dr. George M. Edebohls reports his experience with his method of 
renal decapsulation for chronic Bright's disease. It includes a total 
of fifty-one cases. A number of these are reported in detail. There 
were fourteen deaths, seven within fifteen days of the operation. 
Three of the seven deaths of operative mortality were due to uraemia, 
two to acute dilatation of the heart, one to pneumonia, and one was 
caused by uraemia and cerebral hemorrhage. He had been obliged to 
operate on cases almost moribund. He does not consider the 
mortality a serious one. The greatest danger is from the anaesthetic. 
Of the remaining patients, two did not show satisfactory improve- 
ment, twenty-two are in various stages of satisfactory improvement 
and progress toward health at periods varying from two to fifteen 
months after operation. Tfiey had not as yet passed the probationary 
period of six months of normal urine, before the expiration of which 
no one is entitled to a place on the list of cures. Nine patients were 
cured and remained cured in periods varying from one year and nine 



PROGRESS IN BACTERIOLOGY. l6l 

months to ten years. One patient operated on with one kidney had 
a repetition of chronic Bright's disease after four years. He thinks 
there are two important facts to be recognized : first, that chronic 
Bright's disease in its early stages, at least before serious and fatal 
damage has been done, is curable or susceptible to amelioration by 
renal decapsulation. The second is, that, in competent hands, renal 
decapsulation in the early stages of chronic Bright's disease is 
attended with little or no risk to life. 

In the Journal of the American Medical Association H. J. 
Whitacre, Cincinnati, reported a case of suppression of urine, endur- 
i*^g ^^g^l days, and relieved by decapsulation of the kidneys, A 
woman of forty had previously been in good health. Illness began 
with attempt at criminal abortion ; first by taking drugs, afterwards 
by introduction of a catheter. Following abortion, suppression of 
urine occurred. During first twenty-four hours, a few ounces of 
bloody urine were passed. Suppression lasted about eight days. 
Decapsulation was then done. Right kidney was found very much 
reddened and congested, and had a mottled appearance. On incising 
capsule the cortex bulged. Capsule was stripped off. Cortex was so 
friable that the slightest touch lacerated it. During first twenty-four 
hours after operation patient passed twenty-one ounces of urine ; 
her condition decidedly improved, and the quantity of urine increased 
until she was passing sixty ounces, and a complete recovery followed. 
Nine weeks after operation she was quite well and attending to her 
household duties. The cause of suppression was attributed to vaso- 
motor constriction of the capillaries from the emmenagogues or 
refiexes. It was certainly not a symptom of acute nephritis. 

It is a matter of sincere regret with the reporter that he is unable 
in so limited a time to give an adequate idea of the wealth of material 
that he has had at his disposal. He has had to choose between 
making indifferent excerpts of numbers of articles or of devoting his 
attention to a few. 



Progress in Bacteriology. 

BY R. B. FITZ-RANDOLPH, A. C. F. R. M. S. 
DIRECTOR STATE LABORATORY OF HYGIENE, TRENTON, N. J. 

The attempt to cover, even superficially, the entire ground worked 
over by bacteriologists in the recent past, would be attempting the 
impossible. Although bacteriology is one of the youngest of the 
11 



l62 MEDICAL SOCIETY OF NEW JERSEY. 

sciences, the very important results which have followed its study, 
especially in the field of preventive medicine, the recognition of the 
part that these minute organisms play in the economy of nature, 
and the growing belief that problems of far greater importance 
than any which have so far been attacked remains to be solved, 
has stimulated a very large number of investigators to earnest and 
careful work in these directions. 

I will confine myself this evening to a brief consideration of the 
present state of the bacteriology of a few of the more important trans- 
missible diseases. 

The recent address by Koch,* before the International Tuber- 
culosis Commission, in which he takes the ground that human 
and bovine tuberculosis are caused by different organisms and that 
infection of man by bacilli ilerived from bovine sources does not 
occur, has raised a storm of protest in this country and abroad. The 
work of Trudeau, Ravenel' and others, and the numerous cases 
cited by Ravenel,' Kraus,* Htlls' and many others, show beyond 
doubt, that the position taken by Koch is untenable, and that man 
is capable of being infected with tubercle bacilli from bovine sources. 
Cases where tubercle bacilli from human sources have caused 
tuberculosis in animals are still more numerous. Adami.* whose 
researches in this direction should give his opinion great weight, 
sums up the situation as follows : 

" Bovine tuberculosis can be, and usually is, transmitted from 
cattle to cattle by inhalation or contamination from various dis- 
charges. Human tuberculosis is likewise transferable to cattle, 
but is not markedly virulent except as a mixed infection. Certain 
breeds of swine show more marked susceptibility than others to this 
form of. infection." 

" Human tuberculosis is usually transmitted from man to man, 
and the organism of human tuberculosis varies somewhat culturally 
and pathologically from the bovine variety, but not to the point 
that we should be justified in regarding them as two different 
species. 

" Bovine tuberculosis may be transmitted from cattle to man 
either through wounds, or through the alimentary canal by food, 
the latter form of infection being limited almost entirely to children. 
Milk infections probably take place only in those cases where the 
milk is obtained from cows in which the disease is advanced and the 
bacilli are present in the milk in large numbers. 



PROGRESS IN BACTERIOLOGY. 163 

'* Animals showing either physical signs of tuberculosis or re- 
action to tuberculin should be killed. " 

Adami's statement regarding infection from tuberculous milk 
seems open to question. Mohler^ has made an exhaustive investi- 
gation of a herd of cattle at St. Elizabeth Asylum,- D. C, and finds 
that the tubercle bacillus can be demonstrated in the milk from 
tuberculous cows whose udders show no perceptible evidence of the 
disease, and that the bacillus can be secreted in such an udder in 
sufficient numbers to produce infection in experimental animals, 
both by ingestion and inhalation. Cows secreting virulent milk 
may be affected with tuberculosis to a degree that only can be de- 
tected by the tuberculin test. It would seem, therefore, that any 
cow reacting with tuberculin may be capable of producing infected 
milk, even though she shows no physical signs of the disease. This very 
careful work of Mohler's contradicts the statements of many earlier 
observers who contended that the milk from a tuberculous cow would 
not contain the specific bacillus unless the udder was involved, but 
it throws no light on the actual frequency of infection from milk. 
Kober,^ from a study of a collection of cases of tuberculosis attributed 
to milk, concludes that the evidence indicated that milk spread the 
disease, although the danger was not as great as was commonly 
supposed. Rosenau* has recently shown that a good growth of the 
human variety of the tubercle bacillus could be obtained on the sur- 
face of certain fresh fruits and vegetables in common use. That thi& 
often happens outside the laboratory is somewhat improbable on 
account of the narrow temperature limits within which the tubercle 
bacillus will grow ; it may be, however, that the bacillus can be 
transmitted from man to man through these media. 

Ever since the discovery of the tubercle bacillus by Koch, th^ goal 
toward which all investigators have been striving, has been the attain- 
ment of a cure for the disease. The first attempt made in this 
direction, made by Koch himself, was a method of immunization 
supposed to be produced by the inoculation of a glycerine extract 
of dead tubercle cultures. This method, slightly modified, has 
recently been reintroduced by him, and. while in certain carefully 
selected cases it may do good, yet in the vast majority of instances it 
is of no avail, or even dangerous. This obtains especially with 
Tuberculin T. R., which has been shown by several observers to 
contain at times living and virulent bacilli. Trudeau^*^ in a review 



164 MEDICAL SOCIETY OF NEW JERSEY. 

of recent work in this direction, says that evidence tends to show 
that the attainment of a certain amount of immunity (toxine immun- 
ity), does not protect against reinfection ; whatever immunity is 
produced experimentally is bacteriolytic. A living germ seems neces- 
sary to produce whatever degree of immunity as has been already 
attained experimentally. 

The great majority of mankind possess in greater or less degree 
a natural immunity, but this is only relative, and is maintained only 
as long as the health is kept up to a certain standard. 

The production of a specific anti-toxine has not met with much 
success. The most promising attempt sseem 10 be those of Marig- 
liano and of Fisch, who report improvement in many cases treated 
with their respective sera. It seems probable that some curative 
action may be expected from sera obtained from immune animals if 
a high enough degree of immunity can be obtained. 

An interesting contribution to the serum reaction of tubercle is 
given by Prof. A. E. Wright.** Some years ago Arloing and Cour- 
mont showed a way out of the difficulty, . met with by former 
observers, of obtaining a culture free from clumps. Later Koch 
introduced an improved technique, which consisted in grinding up the 
tubercle bacilli after sterilization of the culture under alcohol. The 
resultant mass when examined microscopically consists of irregular 
detritus with here and there an intact bacillus. This powder is sus- 
pended in normal salt solution by grinding in an agate mortar, and 
centrifugating to remove the larger masses, and the resulting opal- 
escent fluid used in making the test. It is doubtful if this method 
will ever be of value in the routine diagnosis of tuberculosis. It 
should always be remembered that a negative result in any serum 
reaction may mean one of three things ; the absence of the particular 
bacterial invasion suspected, the purely localized nature of that 
invasion, or the absence of the power of immunizing response on 
the part of the organism. The tubercular process is, in the earlier 
stages at least, a purely local one, and we can expect little from the 
serum reaction. It becomes of importance, however, in determining 
the response of the organism when anti-tuberculous innoculations are 
being practised. 

There is little new concerning the bacteriology of typhoid fever, 
except the recent developments in the serum therapy of the disease. 
Two distinct methods of treatment which makes use of the bacillus 



PROGRESS IN BACTERIOLOGY. 165 

typhosus as a starting point, have been developed. One is a process 
of protective inoculation, which consists in the injection of a certain 
amount of dead culture of the bacillus, usually in divided doses. A 
decided reaction ensues and in most cases a considerable degree of 
immunity is developed. This method of immunization has been ex- 
tensively practiced in the English army in India and South Africa, 
with excellent results. Wright*' states that the mortality and also 
the liability to infection in vaccinated over unvaccinated troops is re- 
duced from two to twenty-eight fold. The duration of this immunity 
has not yet been determined with any accuracy. 

A curative serum has been produced by Chantemesse and others 
which recently seems to have been giving good results. Chantemesse* • 
states that in the General Hospital in Paris, where cases were not 
treated with the serum, out of 1,192 cases treated, there were 286 
deaths, a mortality of 19.3 per cent. In two other hospitals in Paris 
where the serum was used, the mortality was in one case 3.7 per 
cent., and in the other under 6 per cent. Fiessinger** reports 300 
cases treated with anti-typhoid serum with a mortality of 9 per cent. 
The difnculty in preparing an active serum seems to be that, owing 
to the toxic products which produce immunity being locked up in 
the bacterial cell, it has been difficult to get enough of the toxin 
absorbed by the animal to produce a high degree of immunity. Some 
recent work of MacFadyen may overcome this difficulty. He grinds 
the typhoid bacilli at a temperature of liquid air, to extract the intra- 
cellular juices which contain the toxic principle. The grinding is 
stated to be so thorough at this temperature that the mass becomes 
sterile from mechanical disintegration of the cells. The resulting 
mass when injected into animals produces a serum which is power- 
fully anti-toxic and bacteriacidal. 

The serum diagnosis of typhoid fever (Widal's reaction) is now so 
firmly established that it is performed as a method of routine diagnosis 
in most, if not all, of the public laboratories of the country. The 
method of Hiss (isolation and identification of the bacilli from the 
feces) while giving positive results somewhat earlier in the disease 
than the VVidal reaction, is not generally used on account of certain 
practical difficulties connected with it. In a large majority of cases, 
cultures properly made from the blood will contain typhoid bacilli 
earlier in the disease than a diagnosis can be made by the serum 
method. This method is one that does not recommend itself to the 



l66 MEDICAL SOCIETY OF NEW JERSEY. 

general practitioner or the diagnostic laboratory on account of the 
difficulty of collecting and transporting sterile blood. Wolf" has 
proposed a modification of the Widal reaction which may be useful. 
He makes a culture from the feces of the suspected case, incubates 
for twelve hours, an^ tests the mixed culture with a known typhoid 
serum. If clumping occurs, the typhoid bacillus is present in the 
feces. He claims by this method to have demonstrated the presence 
of the disease before'the advent of pronounced symptoms. If this is 
really the case, it would seem that his method would be improved by 
adding caffiene to the broth to inhibit the growth of the colon bacillus. 

Many of the sources of typhoid fever are still shrouded in mystery. 
In the majority of cases, aside from epidemics, the source of the 
infection cannot be found. Formerly it was believed water was the 
chief carrier of the disease. While water-borne typhoid is undoubt- 
edly responsible for many epidemics, yet it is gradually becoming 
understood that there are many other sources of infection fully as 
important. The transmission of the disease by flies, and presumably 
by other insects, is now well established. Welch has recently said 
that the majority of cases are not attributable to water, but to direct 
transference from one patient to another, or by things with which the 
patient comes in contact. Milk is an excellent medium for the growth 
of the bacillus, and has been the cause of many epidemics. 

In 1896 an organism was isolated from a case resembling typhoid 
fever, and described by two French bacteriologists, who called it the 
paratyphoid bacillus* *. Recently numerous cases due to paratyphoid 
infection have been reported, and it seems probable that the disease 
is a distinct, or, possibly, two distinct infections. The organisms are 
intermediate in their cultural characters between B typhosus and B 
coli communis. Two distinct types. A and B, have been described 
by Schottenmtiller* ' and carefully studied by Gwyn*», Buxton**, 
Durham***, Gushing**, Pratt*' and others. Members of this group 
ferment dextrose with the formation of gas, thus resembling B coli 
communis ; but do not produce indol or ferment lactose. Both 
paratyphoids produce an acid reaction in milk, the reaction in the case 
of A remaining acid while the terminal reaction of B is alkaline. 
Both species reduce neutral red with the production of fluorescence, 
but with A the red color finally returns. That these two organisms 
are distinct seems probable from their serum reactions. Sera that 
react in high dilutions with variety A will not agglutinate B except in 



PROGRESS IN BACTERIOLOGY. 1 67 

dilutions lower than one to ten, nor will either of the varieties agglu- 
tinate either coli or typhoid sera except in very low dilutions. 

The surest way to diagnose a case is to make cultures from the 
blood in the same manner as is done for typhoid fever. The organism 
has occasionally been recovered from the feces and the urine. If the 
organism cannot be recovered from the blood, a diagnosis is justified 
if the blood from the patient clumps a paratyphoid culture in high 
dilution. Both varieties should be tested. Positive reactions at low 
dilutions cannot be accepted as evidence of paratyphoid infections. 
The mortality from these infections is usually very low, especially in 
those cases caused by variety A. 

Much interest has been manifested in this country during the past 
year in the plague on account of its persistence in San Francisco, 
even after it was officially declared not to exist by the Governor and 
the State Board of Health of California. The action taken by these 
men, presumably for commercial purposes, was as astonishing as it 
was culpable, and they have been unsparingly condemned by sanitary 
authorities both in this country and abroad. Their obstructive action 
is probably largely responsible for the persistence of the plague in 
San Francisco for the last three years, and for its appearance in at 
least one other city in the United States and at Mazatlan, Mexico. 

Calvert*' has recently discussed the transmissibility of this disease, 
and concludes that direct transmission from man to man is not very 
frequent, that water seldom acts a carrier, nor does air, except in the 
pneumonic type. The bacillus is long lived, and is carried by animals, 
insects, raw materials, foodstuffs and the like. A relatively small 
number of the bacilli may cause the disease. 

As with typhoid fever, there have been two specific methods of 
treatment proposed— the method of protective inoculation introduced 
by Haffkine and a curative serum first introduced by Yersin. 
Haffkine's fluid has been largely used in India and in China with 
marked success, and is said to have actually stamped out the disease 
in some localities. This is a good record ; for on account of the 
susceptibility of most animals to the disease, it is very difficult to 
control when once well-established. Contradictory reports have 
been received about Yersin 's serum. Calmette states that it is of 
great value ; its use reduced the mortality in an epidemic which he 
studied from 33 to 13 per cent. Cairns'^ also concludes that it is 
of value, and states that the action is bacteriacidal as well as antitoxic. 



l68 MEDICAL SOCIETY OF NEW JERSEY. 

This double action of the serum is best obtained by its early adminis- 
tration in large doses, both subcutaneously and intravenously. In mild 
cases subcutaneous inoculation suffices. Other observers who have 
had to deal with epidemics of a severer type are not so encouraging 
in their reports, some going so far as to maintain that the serum is 
without effect. The concensus of opinion seems to be that in mild 
cases it is of decided value, in severe cases not of much use. 

In 1898 Shiga*' *« studied an exceptionally severe epidemic of 
dysentery in Japan, and found that while amoebae were never present 
he could recover from the stools of those suffering from the disease, 
and from the organs of those dead from it, a bacillus which aggluti- 
nated strongly with the blood of a dysentery patient. Two years 
later Kruse*^ recovered the same organism during an epidemic of 
dysentery in Germany. Almost simultaneous with Kruse, Flexner** 
and Strong* » reported that these bacilli had been found in cases of 
dysentery in the Philippines. Quite recently Duval and Bassett'® 
have found this bacillus in many cases of infantile diarrhoea. Martin 
and Lentz'*, after a careful comparative study of cultures from various 
sources, came to the conclusion that there were two distinct types, the 
one isolated by Shiga, Kruse, V. Drigalsky, Flexner in the United 
States, and Mttller; the other found by Flexner and Strong in the 
Philippines. These differed in minor cultural peculiarities and in their 
agglutinative reactions. 

The bacillus lies between B coli and B typhosus. It forms no gas, 
and produces acid in milk without coagulation with a subsequent 
return to alkalinity. The formation of indol is doubtful. Its motility 
is also doubtful. Shiga and Flexner claiming that it is motile, Kruse 
and Duval that it is not. Recent work has shown that the bacillus is 
viable in the soil even longer than the typhoid bacillus. It may be 
that this organism has a habitat not yet discovered in nature. 

The preliminary report of Duval and Bassett shows that they 
isolated Shiga's bacillus from forty-two typical cases of summer 
diarrhoea in infants. The organism was isolated from scrapings of 
the intestinal mucosa and in one case from the mesenteric glands and 
liver. The bacillus was found in large numbers in the stools of 
acute cases, but could be found with difficulty in mild and chronic 
cases. The bacillus which they found were identical with those 
described by Shiga, Flexner and others. Agglutination reactions 
were obtained when the blood serum of the patients was tested on 



PROGRESS IN BACTERIOLOGY. 169 

the organisms recovered from them. Reactions were also obtained 
with the serum from the adults suffering with acute dysentery and 
with the serum of animals immunized against the bacillus. The 
bacillus was not found in 24 healthy children, nor in many cases of 
simple diarrhoea, marasmus and malnutrition. They believe this 
bacillus to be the cause of summer diarrhoeas in infants and that 
these are identical with acute bacillary dysentery in adults. 

An attempt is now being made by Flexner and his associates to 
test the efficacy of a curative serum prepared by him, and by autumn 
we will probably know whether or not it is of value in the treatment 
of this disease. 

Only four of the more important diseases have been considered 
and these very incompletely. The recent studies on influenza, scarlet 
fever, variola, rheumatic fever and an attempt at immunization against 
malaria are all of great interest, but the time at my disposal will 
not permit me to discuss them. There has accumulated, a great 
mass of data regarding disinfection and disinfectants, and our practice 
in this direction is slowly becoming scientific instead of empirical. 
Important discoveries have lately been made of the action of some of 
the soil bacteria, in the conservation of nitrogen in the soil. Studies 
of great value are being made on problems connected with water 
supply and sewage disposal, which promise to have important practical 
results, and in many other directions, bacteriology is reaching out 
towards the solution of problems of vastly greater importance than 
any that have hitherto been attacked. 



List of references cited in the text : 

I. — Deutsch. Med. Woch., November 27, 1902. 

2. — Proc. Path. Soc. Phil., May 27, 1902. 

3.-— Ibid, January 1902. 

4. — Muench. Med. Woch., June 21, 1902. 

5. — Ibid, June 17, 1902. 

6. — Manchester Med. Chron., March 1902. 

7.— Bull. 44, Bureau of Animal Ind., U. S. Dep't of Agr., 1903 

8. — Bost. Med. and Surg. Jour., June 11, 1903. 

9. — ^Jour. Am. Med. Ass'n, March 14, 1903. 
10. — Bost. Med. and Surg. Jour., June ix, 1903. 
II.— Lancet, May 9, 1903. 
12. — Ibid, September 6, 19C2. 
13.— La Press. Med., 1902. 
14. — Jour, des Practiciens, No. 11, 1903. 



I70 MEDICAL SOCIETY OF NEW JERSEY. 

15.— Am. Jour. Med. Science, April 1903. 

16.— Bull, et Mem. de la Soc. med. des Hospitaux de Paris, 1896. 

17.— Zeit. f. Hyg. u. Infectionsk.. 1901. 

18.— Johns Hop. Hosp. Bull. 1900. 

19 —Jour. Med. Research, 190a. 

20. — ^Jour. Exp. Med., 1901. 

21.— Johns Hop. Hosp. Bull , 1898. 

22. — Bost. Med. and Surg. Jour., 1903. 

23 — Am. Med., January 24, 1903. 

24 —Lancet, May 9, 1903. 

25 —Cent, f Bact., Bd. 23, H. 14, 1898. 
26.— Ibid Bd. 24. H. 22-24. 1898. 
27.— Deutsch. Med. Woch., H. 40, 1900. 
28.— Cent. f. Bact., Bd.28. H. 19, 1900. 
29 — Rept. Surg. Gen. U. S. A., 1900. 
30. — Am. Med., September 13, 1902. 

31 —Zeit. f. Hyg. u. Infectionsk. Bd. 41, H. a, 1902. 



Progress in Ophthalmology. 

BY TALBOT R. CHAMBERS, M. D. 

The death of the great Dr. Panas, of Paris, is recorded. During the 
past year there has been a marked increase in trachoma and follicular 
conjunctivitis in Hudson county, as elsewhere throughout the country. 
Our experience with argyrol leads us to corroborate the findings of 
Dr. A. Darier. In a paper read before the Paris Opthal. Soc, April 
7, 1903. he said if protargol was good, why seek something better. 
But argentamine was better. Argyrol is better still. It is a long 
step forward in the treatment of diseases of the eye It is painless 
and yields better and quicker results than we have yet been able to 
obtain with any other silver salts. Adolph Alt, St. Louis, in the Am, 
Jour, OphihaL, October 1902. states he has used the 5 per cent, 
solution with similar success. Dr. J. Pedersen of New York, and 
others have written of its superior advantages in catarrh elsewhere 
in the body. 

Speaking of trachoma, the Medical Inspectors in Prussia, did not 
find a single school in which there was less than 5 per cent, of the 
scholars infected. In the villages the proportion averaged from 20 
to 48 per cent. Raehlmann states that more than half a million per- 
sons suffer from trachoma in three provinces alone. The government 



PROGRESS IN OPHTHALMOLOGY. l/I 

appropriates $87,500 every year to fight it, but still more energetic 
measures are demanded by the Berlin medical press. In Brooklyn 
over 2,000 pupils were excluded from the schools this year because of 
eye disease. 

Dr. M. S. Mayon, Lancet, Feb. 28, 1903. discusses the use of X-rays 
in rodent ulcer of the cornea and trachoma. He says : " Here we have 
a method of setting up a leucocytosis with the absolute minimum of 
destruction to epithelial and other structures." After trial with 
fifteen cases, he claims : i. There is considerable less deformity in the 
lid than after the old established means of cure by operation and 
caustics. 2. It is practically painless. 3. Pannus clears more 
thoroughly. His full article should be read by one before beginning 
the treatment. Others have written on the subject, but this author is 
selected for this report. 

Kipp, Am. J, of Oph., Vol. XIX, No. 12. reports a case of epithel- 
ioma of the ocular conjunctiva — excision — many relapses, but final 
cure, with remarks on the microscopical examination by Adolph Alt, 
of St. Louis. 

Kipp, yi7«r. A. M. A., August 9, 1902, shows the great value of 
the gal va no-cautery in treatment of serpiginous ulcer of the cornea. 

Dr. Wm. A. Fisher, Chicago, in the Opk. Record. January, 1903, 
in reporting 1 50 magnet operations says : " No delay should be toler- 
ated when a foreign body has entered the eye-ball. If the object be 
iron or steel, the sideroscope may be used, but one should not wait 
for an X-ray picture to be developed. Sightless, quiet eyes that 
appear perfectly normal are preferable to glass eyes." He says that 
" he is willing to affirm that there is no metal in the suspected eye 
when he cannot find it with the giant magnet and have a negative X-ray 
picture." 

Kipp, Arch. Oph.,Vo\. XXXI, No. 4, calls attention to the removal 
of a large piece of iron from the eye-ball after failing with the mag- 
net. He simply reversed the magnet and the foreign body revolved 
on its axis, and was instantaneously removed. 

Dr. A. Ramsey, Glasgow, Lancet, January 31, 1903, enucleates the 
eye. but takes care to catch hold of the muscles with silk before 
severing them from the ball, and he passes a stitch through the 
conjunctiva to make a purse opening through which he inserts 
sufficient paraffine to suit the case and closes the wound. He inserts 
a shell in one week and has only four failures out of twenty-two cases. 



172 MEDICAL SOCIETY OF NEW JERSEY. 

Oatman, of Brooklyn, Med. Record, March 7, 1903, inserts a 
paraffine ball instead of glass in doing the Mule's operation. 

Roemer, Archtv, fur Oph, LV., Ban. 2. Heft, in an exhaustive 
article, states sympathetic ophthalmia is due to an infection which for 
the eye is pathogenic, but which is indifferent so far as the rest of the 
body is concerned, and which reaches the other eye by metastasis, 
possibly by way of the circulation. H. Gifford, Omaha. Archtv, 
OphthaL, November, 1902, has an able article on the history of the 
theory of sympathetic ophthalmia. 

H. M. Starkey, Chicago, J. A. M. A., April 25, 1903, has an exhaustive 
paper of great interest and value. The discussion of the paper by 
eminent ophthalmologists on the subject — " The Use of Mydriatics 
After the Age of 45 " — is found in connection with the article. His 
conclusions are : " No age can be arbitrarily fixed beyond which 
cyclopegics must not be used. They are required in fewer and fewer 
cases as life advances, but since there is more danger of glaucoma in 
the elderly, these drugs should be used with caution after the age of 
40, and in certain cases not at all." 

H. V. Wurdemann, Annals Oph„ April, 1903, reports a case of 
pulsating exophthalmos as cured by ligature of the common carotid. 
The external was first tied, but the bruit and exophthalmos persisted, 
so the operation was extended to occlude the common carotid. The 
exophthalmos, the noises in the head, the headaches and the general 
nervous disturbances disappeared, and nine months later the patient 
seemed to be permanently cured. He says that enucleation, which 
had been advised, in this case would have been a grave mistake, 
as the varix behind the ball would certainly have protruded in a mass 
between the lids, causing dangerous bleeding. 

Dr. S. D. Risley, Philadelphia, Annals of Gynecol, and Pediatry, 
March, 1903, claimed that 88.81 per cent, of the children in the public 
schools manifested some congenital defect. In many instances, the 
child, with uncorrected error of refraction, for instance, was unfitted 
to bear the strain of the struggle with books. A card of test letters 
was published, with instructions as to its use printed on the back, and 
distributed to the schools. The plan required the teacher of each 
class to determine the sharpness of vision of each eye of every 
member of the class at the beginning of the school year, and to 
record the findings on a blank furnished for the purpose. If the 
acuity of vision fell below a prescribed standard, a card was provided 



GYNECOLOGY. 173 

to be sent to the parents of the child, on which the fact of the defective 
eyes was briefly stated and professional advice advised. Without 
exception, every child presenting one of these cards at Willis Hospital 
clinic was in need of professional advice. 



Gynecology; Its History and Development. 

BY JOSEPH M. RECTOR, M. D., JERSEY CITY, N. J. 

In asking your attention to a brief review of the history of gyne- 
cology, I fear that the repetition of well-known facts may prove unin- 
teresting and that I may be presuming upon your good will in taking 
so much of your valuable time to consider the manner in which this 
branch of medical learning had its beginning and through what diffi- 
culties it passed before being recognized as an individual branch of 
medicine and surgery. 

To appreciate what has been accomplished in gynecology, one 
must be in possession of the knowledge of what has been done in the 
past, what methods were adopted, what struggles were overcome, 
what difficulties were encountered and with what fortitude the early 
physician and surgeon battled as against long established customs, 
ignorance and superstition, in laying the foundation for future success, 

The Egyptologists inform us that a knowledge of medicine existed 
three thousand years before Christ. Pliny tells us of a school of 
medicine at Alexandria during the reign of the Ptolemies. Among 
the hieroglyphics the shape of the uterus can be recognized. Six of 
the forty-two volumes attributed to Hermes refer to medicine, and 
the sixth treats of the diseases of women. The Hippocratic collec- 
tion includes among its monographs one upon the diseases of women. 
In the books of Moses reference is made to the hymen and menstru- 
ation. St. Luke says, " a woman having an issue of blood twelve 
years, which had spent all her living upon physicians, neither could 
be healed." 

The real history of gynecology begins with the writings of the 
Greek school. There we find mention of displacements, metritis, 
and disorders of menstruation. Celsus, Galen and Aretaeus describe 
leucorrhea, ulceration of the uterus, the discharging of products 
through the vagina and rectum, and mention of the vaginal speculum 



174 MEDICAL SOCIETY OF NEW JERSEY. 

as distinct from the rectal speculum. Soranus the younger, about 
220 B. C. wrote a treatise entitled, ** De Utero et Pudendo Mulicbri," 
describing the sexual organs, the changes in the os uteri during 
pregnancy, the difference between pregnancy, ascites and solid 
tumors. He understood digital examination and the use of the 
sound and speculum. 

From this time until the time of i^tius the records are uncertain, 
and I am unable to relate what progress, if any, was made, ^tius, 
five hundred years after Christ, in his works, on record in the library 
at Alexandria, in the sixteenth book, speaks of periuterine cellulitis, 
vaginal injections, caustics in the treatment of ulcers of the cervix and 
the use of the sound for replacing the uterus ; the use of the specu- 
lum, sponge tents, pessaries, and the importance of hip baths ; the use 
of galls, rose oil, barley, alum and linseed. 

In the year 640 A. D. the library of Alexandria was destroyed by 
the Saracens, the laws of Mohammed forbade the examination of 
women by men, and as a result we find an absence of investigation 
and learning until the end of the eleventh century, when Albucasis 
wrote and taught upon this subject. This period is known to history 
as the *' dark ages." It extended from this time until the sixteenth 
and seventeenth centuries. There are no authentic records indicating 
any material advancement, but in its stead we find chaos, ignorance, 
superstition and unnatural conditions prevailing. The learning of 
the Greek School was forgotten, the Arabian School, which in the 
beginning attempted to fashion itself after the teaching of the Alexa^i- 
drian physicians, soon became disorganized and fell to decay. 

The practice of obstetrics during these centuries was left to mid- 
wives, and these, for the most part, were ignorant'and filthy old women, 
slaves of routine procedures that had obtained from time immemorial, 
and there was nothing accomplished. In the beginning of the 
sixteenth century, prejudice gradually gave way to progress and the 
enlightened physician once more began his onward march of edu- 
cation and advancement. At this time the separation of the priest- 
hood from medicine was completed, schools of medicine were 
improved ; hospitals, dispensaries and societies were organized. The 
different governments enacted laws for the protection of the public 
from imposition and quacks, witches, mountebanks, vagrants, barber 
surgeons and magicians disappeared. 

Educated obstetricians then appeared. Their teachings embraced 



GYNECOLOGY. 1 75 

not only obstetrics, but gynecology as well. What could be a more 
natural or systematic classification at this time, than the placing in 
one catagory, the allied subjects of obstetrics and gynecology. As it 
requires the normal healthy vulva, vagina, cervix, uterus, fallopian 
tubes and ovaries to give to women the special functions of her sex 
in natural menstruation, copulation, conception and successful preg- 
nancy, so it is the same organs, but in their changed and diseased 
conditions, that render possible the science of gynecology with the 
assistance it extends to suffering womankind. 

Ambrose Pare was the first man of prominence at this time. His 
work was mainly that of a surgeon, but in his pupil. Jacob (suillemearu, 
who flourished in 1 550-1603, we find his ideas on obstetrics and 
gynecology well advanced. The use of the vaginal speculum is once 
more described, methods were adopted to hasten the delivery of 
pregnant women because of hemorrhage or puerperal convulsions. 
The Caesarian operation, first described by the Greeks and Romans, 
which had fallen into disuse during the middle ages, was once more 
revived. Rousset reported successful cases, and among others, that 
of a woman upon whom this operation had been performed six 
times. Louis Bourgois, in 1626, published a treatise upon abortion, 
sterility, fecundity, accouchement and diseases of women and child- 
ren. Mauriceau, of Paris, wrote a monograph upon disease of 
women, pregnancy and childbirth. The Chamberlains in England, 
fashioned an instrument to aid in the delivery of the arrested foetal 
head. Portal was the first to propose version by one foot. In 
Germany, Justine Siegemundin. the court midwife, advocated puncture 
of the membranes for artificial delivery, and bi-manual version to be 
used in abnormal presentations. Degraaf, about 1650, described the 
ovarian follicles, which to this day bear his name. Stenau mentions 
the uterus as a muscular organ, and Hoboken, of Utrecht, very 
accurately described the placenta and the coverings of the ovum. In 
1721, Palfyn, a surgeon of Ghent, while attempting to outdo the 
Chamberlains succeeded in making two steel spoons which was a 
more useful and better instrument, whereby he received honor as 
being the inventor of the forceps. William Smellie about 1740 modi- 
fied the instrument of Palfyn ; called attention to the importance of a 
knowledge of deformed pelvis ; distinguished one diameter from the 
other, and pointed out the usefulness of cephalic version and version 
of the breech. William Hunter, his cotemporary, agreed with 



176 MEDICAL SOCIETY OF NEW JERSEY. 

SmcUie, excepting that he could find no use for artificial aids or in- 
struments at delivery. In 1761, Astruc described the occlusion of 
the vagina, obstruction to the menstrual flow and gave directions for 
a vaginal examination. 

This, gentlemen, brings the study of our subject to the great nine- 
teenth century. You, who have spent the greater part of your lives in 
its closing years, and we who are just beginning to realize its magni- 
tude, can look back and with wonder and amazement behold the 
rapid strides that have been made in every department of art and 
science. The wheels of time have rolled by, and with each revolu- 
tion we have seen the years of marvelous progress, the wonderful 
discoveries that were made, the constant spirit of unrcstfulness, the 
ever seeking desire for truth and the ever eager mind of man grasp- 
ing for some gleam of light which would clear the darkness from 
some hidden mystery. One by one, beliefs which have stood from 
time immemorial were swept away, scientific creeds were proven to 
have been false, logical deductions were shown to have been the 
results of false premises, while cherished traditions which had held 
their place until this time were soon forgotten, and in their stead we 
find the truth of modern thought. In short, it is but the proof that 
while the mind of man was always great, the mind of the nineteenth 
century is the greatest of them all. 

In the midst of all this educational advancement and progress we 
find the study of medicine and surgery had not been forgotten. In 
the first half of the century there was no distinct division of one 
branch or another, yet there was a constantly growing tendency 
among the able men to give their attention more to one subject than 
to another, probing deeply into the problems that confronted them 
and attempting to advance the special subject of their interest 
beyond that of the others. 

In 1 801, Recamier, a man not so much of originality as practica- 
bility, made himself known by advancing to the first place the use, as 
scientific instruments, of the vaginal speculum and uterine sound. It 
is not to be supposed that he was the inventor of these instruments, 
nor are there any particular modifications bearing his name. Their 
constant use and practice had enabled him to recognize their value 
and by their means to demonstrate to his confreres the benefit of a 
visual examination of the vagina and cervix, the exploration of the 
uterine cavity, and by use of a small scoop or curette he scraped its 
mucus membrane. 



GYNECOLOGY. 1 77 

Following upon his advice Melier, in 1832, suggested local treatments 
and injections into the cervical canal; Guilbert, in 1826, applied 
leeches to the cervix ; Huguier, Kiwish and Simpson, in 1828, advo- 
cated their use and did their utmost to interest their fellow gynecolo- 
gists in their value as an aid in diagnosis and treatment. Dr. Bennet, 
of London, in 1845, edited a work upon " Inflammation of the Uterus." 
He claimed that the main cause of uterine diseases was inflammation, 
which resulted in ulcerations, displacements and pathological condi- 
tions of the appendages; leucorrhcea and abnormal menstruation 
were largely symptoms of this diseased state ; inflammatory action 
remained mostly within the cervical canal, and the application of 
strong caustics was the proper treatment for the disease. It is safe 
to say that no work appeared at this time which did so much to 
advance the knowledge of uterine pathology. As the result of these 
assertions, the gynecologists at once arrayed themselves against 
him. question after question was reviewed, theories and reasons were 
assailed, and Dr. Bennet found his views attacked by such able men 
as Drs. Lee, West, Tilt and Tyler Smith. Dr. Tilt, in 1850, published 
a book upon the subject of *' Ovarian Inflammation," in which the 
following deductions were made: ist. Greater practical importance 
should be recognized in the inflammations of the ovaries ; 2d, rarely 
is the entire ovary diseased ; 3d, pelvic diseases of women begin with 
morbid ovulation ; 4th, ovaritis is most frequently due to morbid 
ovulation ; 5th, ovaritis often causes pelvic peritonitis ; 6th, the ovary 
and the oviducts are the frequent cause of free blood in the peritoneal 
cavity ; 7th. ovaritis is the forerunner of disturbed menstruation ; 
8th, ovarian tumors are caused by abnormal graafian cells. 

In 1854, the subject of uterine displacements and their importance 
in relation to uterine disease received attention. Velpeau, in France, 
is quoted as saying. " I declare, nevertheless, that the majority of the 
women treated for other affections of the uterus have only displace- 
ments, and I afiirm that eighteen times out of twenty, patients suffer- 
ing from disease of the womb or of some other part of this region, 
those, for instance, in whom they diagnose engorgements, are affected 
by displacements." Graily Hewitt, in his publication, " Diseases of 
Women," speaks as follows: *' ist. Symptoms of uterine inflamma- 
tions are often found associated with flexion or alteration in the shape 
of the uterus.' 2d. Chronic inflammation causes changes in the shape 
of the uterus. 3d. Flexion of the uterus acts constantly as the cause 
of chronic inflammation." With this stimulus at hand, all physicians 

18 



178 MEDICAL SOCIETY OF NEW JERSEY. 

and gynecologists examined every complaining woman for flexions 
or versions of the uterus, and each in turn invented some matsmmeat 
or pessary for its relief, or else modified the paittffii «l someone else. 

Sir John Williams wrote an excellent moBOgraph, " On the Circula- 
tion in the Uterus," pointing cot tbe course and direction of the blood 
supply, deducing tbcrefronr the cause of passive congestion as occur- 
ing in the vtTMOt» and flexions of the uterus and also in the proci- 
dentia. POtk and Barbour described the fact that in the pregnant 
oterns at term the relations of the pelvic peritoneum behind and in 
front were the same as in the non-pregnant uterus, while at the 
sides the pelvic peritoneum is lifted high and on a level with the 
pelvic brim. Dr. Stephenson proved the peculiar property of the 
uterine peritoneum in yielding to a gradual growth for an unlimited 
extent while rupturing under a sudden force. 

The next marked advance in gynecology was the fixed recognition 
of successful ovariotomy, and to Dr. Ephraim McDowell is the honor 
due. The story says that in 1809 a poor woman travelled sixty miles 
upon horseback to have an ovarian cyst removed. A nine-inch 
incision was made to the left of the median line, the cyst punctured, 
a suture applied about the broad ligament near the uterus and the 
sac removed. The operation was finished in twenty-five minutes. 
Repeating the report of Dr. McDowell, " In five days I visited her, 
and, much to my astonishment, found her engaged in making up her 
bed. I gave her particular caution for the future, and in twenty-five 
days she returned home in good health, which she continues to 
enjoy." So may we rightfully accord to this good man the first place 
in abdominal surgery. I do not mean to convey the idea that removal 
of the ovary for disease originated with Dr. McDowell. The records 
show that Dr. Clay, of Manchester, in 1842, published a series of 
cases for which ovariotomy had been tried. Dr. John Bell, of 
Edinburgh, lectured upon the possibility of relief in such treatment, 
nevertheless, the fact remains that the operation was not endorsed 
and the confidence of the profession was not established until the 
successful operations were performed by Dr. McDowell. With the 
advancing knowledge gained by these abdominal sections, the questions 
arose as to the best method of treatment for the stump, whether 
extra or intra-peritoneal. In 1850 Mr. Duffin insisted that the stump 
should be treated extra-peritoneal and the clamp used, 'Baker Brown 
employed the cautery with the stump extra-peritoneal, Tyler Smith 
returned the ligated pedicle. 



GYNECOLOGY. 1 79 

Spencer Wells, in 1864, published a work upon "Abdominal 
Tumors." He mentions the fact that researches and investigations 
were now begun as to the relative merits of the clamp, ligature and 
and cautery. He applauded the method of Mr. Duffin, and speaks of 
experiments to ascertain the ultimate condition of ligated stumps left 
within the abdominal cavity, and praises Koeberle for his study of the 
effects and results in abdominal drainage. Among other subjects he 
mentions the results of experimentation upon animals, conducted for 
the purpose of determining the process of healing when the cut peri- 
toneal edges were or were not held into opposition by suture. In the 
former instance, the inner lining of the abdominal wall is again made 
perfect, intestines or omentum do not adhere and post-operative 
hernia is rare ; in the latter, retraction of the cut edges occurs, direct 
union is wanting, omentum or intestines adhere to abdominal wall 
and post-operative hernia is frequent. The after-treatment of abdom- 
inal cases is discussed with special reference to the use of opium, 
feeding, stimulation and sequella. 

Thornton, in 1890, reviewing the results of abdominal surgery up 
to the year 1876, writes as follows : " We first have the general want 
of cleanliness and the lack of all appreciation of knowledge of what 
constituted surgical cleanliness, then the long ligature and the clamp, 
both clumsy and unscientific and both specially suited to make the 
want of cleanliness more deadly ; and then following with an appre- 
ciable but far different influence, we have delay in operating, tapping 
and the long incision. Then I must not forget drainage, for I think 
it is highly probable that a good system of drainage, such as we now 
have, thanks to Koeberle and Keith; would have done much to 
counteract the evils I have named above, though the frequent use of 
the drainage tube, with the long ligature and the clamp, would have 
introduced new elements of risk which I shall have to refer to again 
when I speak of the place which drainage occupies in the successes 
of to-day." 

With the impetus thus far given to abdominal surgery it is not sur- 
prising to find the next step was the removal of the fallopian tubes 
and ovaries for other pathological conditions. In 1872, Lawson Tait, 
Battey and Hegar became known to us because of their labors in this 
direction. To Tait belongs the credit of removing the appendages 
for pathological lesions, to Battey the removal of the normal ovary to 
relieve various neuroses which he believed were caused or aggravated 



l8o MEDICAL SOCIETY OF NEW JERSEY. 

by the changed or altered function of the ovary, and to Hegar the 
removal of the ovaries for the cure of uterine fibromata. 

Following closely upon the operations for ovariotomy and salping- 
otomy came the further development and enlargement of abdominal 
surgery in the removal of the uterus for uterine fibromata. At first 
the mortality was high— in 1883, Tait, Martin and Schroeder had a 
thirty per cent, record of death. Keith was more successful because 
of the larger experience gained from the labors of those before him. 
He succeeded in lowering the mortality to an even basis with ovari- 
otomy. Dr. Apostoli now appeared as the champion promoter of 
electricity in the treatment of uterine fibromata. His contention was 
the reduction of the size and in many instances their entire disappear- 
ance. A large clay pad was used upon the abdomen which held in 
place the positive pole, an insulated sound was passed into the uter- 
ine cavity and a current of from 50 to 100 milliamperes was allowed 
to pass. 

In 1883, Dr. Tait first called attention to the frequent occurrence of 
ectopic gestation and in the same year succeeded in performing his 
successful operations. The cause at first explained, in the abdominal 
form, was due to the fertilized ovum having fallen into the peritoneal 
cavity in its journey to the fimbriated extremity of the tube. Pelvic 
hematoceles and hematomas were now recognized as the result of the 
rupture of the fallopian tubes, hemorrhagic peritonitis or rupture of 
the veins in the broad ligiment. In 1892, Mr. Bland Sutton described 
the existence of the tubal mole. 

Malignant disease of the uterus during this time was receiving its 
equitable share of attention. Church, in 1864, makes mention of the 
affection, Denman writes of the misfortune in not having a classifi* 
cation of the existing varieties. Tilt, at times, mistook it for uterine 
fibromata. Dr. John Clark caused the name of " corroding ulcer, " to 
be applied to it. Waldeyer and Thiersch were among the early oper- 
ators who described the disease as beginning in the glands of the 
parenchyma. Sir Charles Clark believed the usual origin to be in 
the cervix, because of its glandular composition. Rugie and Veit 
conducted a series of investigations to determine the difference be- 
tween glandular erosions of the cervix and the early signs of true 
cancer. 

Until the year 1857 it was the custom of the gynecologist to attri- 
bute the cause of phlegmon, pelvic exudations, pelvic abscess, para- 



GYNECOLOGY. l8l 

metritis and the like to inflammation. The inflammations were 
thought to occur in the connective or cellular tissue of the true pelvis. 
The first marked attention was given between the years 1840 and 
1844, when Churchill, Doherty, Calvi and Bourdon contributed 
largely to the literature on these subjects. Bernutz, in 1857, at a 
post-mortem examination of a woman supposed to have died of peri- 
uterine phlegmon, discovered the true cause. The leison did hot 
effect the cellular tissue, but consisted of an abscess whose walls 
were formed by the adhesions between rectum, bowel, bladder and 
uterus. As a result of similar cases and post-mortem findings, he 
concluded that: i. Pelvic peritonitis was a frequent disease ; 2. 
The mass found to exist after death from pelvic peritonitis was due 
to adhesions of the various pelvic organs as being the result of this 
disease ; 3. Inflammation of the pelvic cellular tissue was sympto- 
matic only, such symptoms being due to inflammatory disease of the 
fallopian tubes or ovaries. 

Dr. Thomas, in 1880, gave expression to the following: " i. Peri- 
uterine cellulitis was rare in the non-parous woman, while pelvic 
peritonitis is exceedingly common. 2. A very large proportion of 
the cases now regarded as instances of cellulitis were really cases of 
pelvic peritonitis. 3. The two affections are entirely distinct from 
each other and should not be confounded simply because they often 
complicate each other. 4. They may usually be differentiated from 
each other and a neglect of the effort at such a thorough diagnosis is 
as reprehensible as a similar want of care in determining between 
pericarditis and endocarditis." 

Hart and Barbour, in 1886, placed inflammatory diseases of the 
pelvis, either peritonitis or cellulitis, under the one head, their 
symptoms being correlative and their lesions similar in nature and 
extent. Doran, in 1893, records the history of tubercular disease, 
beginning in the tubes and ovaries and spreading to and involving the 
peritoneum, causing a tubercular disease of this membrane. 

No greater stimulus was ever given abdominal surgery than the 
discoveries of Lord Lister. The gynecologist hailed with delight the 
dawn of antiseptic surgery, its principles were readily mastered and 
the practice was quickly formed. At once the high death rate was 
lowered, the anxious fear of the surgeon was dispelled, post-operative 
inflammation, per se, quickly became a relic of the past, while the 
everlasting gratitude of suffering womankind raised its voice and sang 



1 82 MEDICAL SOCIETY OF NEW JERSEY. 

aloud the immortal names of Lister, Koch, Tyndall and Pasteur. 
From antiseptic surgery as a parent, the child, aseptic surgery, was 
soon born. Time has developed its life until to-day, we stand upon 
the pinnacle of fame whose foundation was fashioned by the mighty 
hand of Lister. 

About the middle of the nineteenth century there appears in our 
country, a name most dear to us all, Marion Sims, the father of 
modern surgical gynecology and the pioneer of plastic vaginal 
surgery. Can you picture in your mind a more glorious triumph to 
him than when he beheld the poor negro woman tramping through 
the dusty southern roads, miles and miles, to worship at his shrine ? 
And again, imagine their joy at being relieved of that most dreadful 
malady, the vesico-vaginal fistula. It is for this victory that the medi- 
cal world gives to him the honor he has so rightfully gained. With- 
out earnest thought, gentlemen, you can hardly appreciate the 
wonderful gain thus made or the triumph achieved. Think for a 
minute the condition of the poor, helpless woman, a suppliant before 
your eyes, her foul smelling clothes and her mental anguish, an outcast 
from society and a sufferer until this time for the rest of her mortal 
life. It reminds me of the biblical cry of the leper, " I am unclean." 

It was in 1852 that Sims perfected his technique of healing the 
torn bladder floor. His main points of originality were: ist, the 
perfected speculum ; 2d, the suture which would not irritate the tissue ; 
3d, the complete drainage of the bladder during the healing of the 
fistula. Thomas Emmet should receive mention here partly as a 
contemporary and partly because of his conciseness, practical thought, 
intelligence, and that certain aptitude of application which is born of 
and associated with skill and genius. 

With the teaching of Sims we may well mark the beginning of 
modern gynecology. The fashioning of his speculum, his methods 
of pelvic and vaginal examination, his original ideas, operations, 
management of cases and routine methods of treatment startled the 
medical and surgical world and awakened an interest which has since 
followed in this special line of thought, giving possibilities which 
before were scarcely dreamed of. Medical colleges recognized the 
advancement, practitioners of medicine saw and felt their deficiencies, 
while post-graduate students at once deemed it necessary to perfect 
themselves in this new specialty before they could believe themselves 
proficient and well qualified to act as family physicians in the honest 
care of wives, mothers and daughters. 



GYNECOLOGY. 1 83 

As the old adage tells us, " History repeats itself;" so it is true with 
gynecology, that from its inception as a modern study until the present 
day, gynecology has passed through all the varying dogmas and doc- 
trines to which this or that discovery has given rise. At first every 
woman who had borne children was thought to possess an inflamed, 
engorged or ulcerated cervix, and for her well-being local applications 
were a necessity. All headaches, backaches, disturbances of vision 
and general neuroses were thought to be the result of uterine displace- 
ment, and the age of the pessary was at its height. Oophorectomy 
was the cure-all for hemorrhagic fibroids, hysterical neuroses and 
obscure pelvic pain, until, after such castrations, a train of nervous 
phenomena supervened which often ended in delirium, loss of mental 
power and, finally, insanity. Cellulitis at one time was the name 
given to all exudations, inflammations and deposits around and about 
the uterus and in the broad ligament, hot water douches and topical 
applications were in vogue with the oft-repeated visits to the doctor's 
office and the oft-repeated tale of woe, " Doctor. I am no better." 

It needed but the test of experience and practice to point the error 
of our ways. Success is not always the immediate reward of a 
speculative beginning ; it is the result of progress and exact truth 
gained from repeated mistakes and trials. Knowledge and learning 
are the rich returns of investigation and experimentation. Surgical 
research and the untiring work of mighty minds have taught us to 
revolutionize our ideas of early gynecology. Hypertrophy, erosions 
of the cervix and ulcerations of the everted mucous membrane are the 
results of lacerations which trachelorrophy or amputations of the 
cervix will cure. The dynamics of the uterus teach us the etiology of 
the mechanical versions and flexions. A more intimate knowledge of 
inflamed and adherent tubes and ovaries compel us to forget that 
cellulitis as an individual disease was ever thought to exist. How 
many good women have lost their lives or have been condemned to 
invalidism because of the belief furnished by the older physicians that 
uterine hemorrhage or foul discharge after the climacteric were but its 
inherent cause or peculiarity, which we now know to be the result of 
fibromata, carcinomatous or sarcomatous growths, the early recogni- 
tion and thorough extirpation of which will prolong the life if not 
entirely cure the unfortunate woman. 

The performance of abdominal section by men skilled in this work 
resulted at once in a great lowering of the mortality, and rightfully 



1 84 MEDICAL SOCIETY OF NEW JERSEY. 

should it be, engaged as such men are in selective surgery alone, 
unhampered by the constant septic cases of the general surgeon. 
The earliest records of low mortality were the work of Thornton, 
Sinclair, Keith, Tait and Bantock in England, and in this country by 
Thomas. Dunlop, Atlee, Peasley, Kelly and many other equally 
brilliant men. The perfect removal of ovarian cysts, the amputation of 
infected fallopian tubes, the position of Trendelenburg which gives to 
the surgeon a clear field, an unobstructed view, are all the results of 
laborers in this special branch of surgery. 

The early opprobrium of the laparotomist, the fistula which often 
followed his work, is now relegated to the past, as the gynecologist 
has adopted the use of catgut in the place of the non -absorbable silk 
suture. How often has the surgeon feared the result when he was 
compelled to tie his uterine, tubal or ovarian stump with a large cable 
of silk, and this mode of procedure was popular in the early days of 
my surgical work. 

The frequent starting point of carcinoma was found to be in the 
much abused cervix, and the gynecologist at once rid the body of this 
danger. Early plastic work upon the perineum was sufficient if it 
made the vulva appear healed ; the cosmetic effect was good, but the 
pelvic fascia and the torn perineal muscles were as widely apart as 
after the time of rupture. It is a sad spectacle to me to-day to see 
the older physician and surgeon attempt to unite the torn muscles, 
fascia and skin with one broad, sweeping or bunching vulval suture, 
evidently forgetting his anatomy or the action of the torn tissues 
which he in vain seeks to unite. Plastic vaginal surgery offers the 
correct method of dealing with this class of injuries, and when the 
physician or surgeon is unable to pursue the proper technique, it is 
far more laudable to call his able brother's assistance than for him to 
fail or to have such a stigma placed upon him. 

The queston of proper support for the relief of uterine versions and 
flexions, while not as yet satisfactorily settled, is fast nearing perfec- 
tion in the hands of Alexander, Kelly, Dudley. GofT and Mann. 
Inflammatory conditions and new growths of the bladder are fast 
yielding to the skillful work of Pawlick, Emmet, Skene and Kelly. 
Complete procidentia of the uterus, at first treated with tampons and 
pessaries, are now relieved by combined plastic and abdominal work. 
Pathological lesions and accidental division of the ureters are no 
longer a reason for the death warrant of our patient, as Kelly, among 



GYNECOLOGY. 1 8$ 

others, has given us a plan of treatment for these unfortunate condi* 
tions. Posterior vaginal section is the work of the gynecologist ; by 
its means the vaginal route to the pelvis and abdomen supersedes the 
abdominal in many and appropriate cases; its advantages are too 
well known to you all as a recent procedure to bear from me a repe- 
tition here. 

So, gentlemen, might I continue to chant the praises and the blessings 
which honestly belong to the labors of the gynecologist. Time, 
study and persistency have caused him to advance and so will he 
continue to advance until the diseases peculiar to women no longer 
exist. In the records of history and fame you will find the names of 
Kelly, Baldy, Boldt, Cragin. Davis, Skeene. Grandin, Mann, Price, 
Bovee. Pryor, Thomas, Munde. Barbour. Hart, Thornton. Playfair 
and hosts of other brilliant men who have spent the greater part of 
their active lives in the labors of this useful field. 

It is strange that the general surgeon should wish to deprive the 
gynecologist of his rightful place, to usurp as his own the great work 
that has been done, to belittle the value of further special work now 
that almost perfection has been reached, and the gynecologist has 
taught the surgeon all that is known concerning pelvic and vaginal 
surgery. There is no need for jealousy or envy upon the part of 
either one ; there is abundance of work for all and great need for 
skilled men in either branch. 

If the dissatisfied or ambitious surgeon will stop to reflect for one 
moment, he will readily see that one man's mind is not thoroughly 
capable of mastering the great knowledge or technical skill required 
for perfection and proficiency in every branch of surgery. The do- 
main of surgery in the twentieth century is one of constant progress, 
and is far too large for the feeble faculties of one possible master 
mind. The laity will acknowledge our worth and value by the 
amount of learning we possess and the cunningness of art and skill 
we display, giving no thought of recognition to the multitude of 
subjects we unsuccessfully attempt to crowd within the narrow 
confines of one mortal mind. 

. The surgeon does not believe the great field of general surgery is 
perfect and complete ; that further progress is no longer possible ; 
that he need not confine himself exclusively to his chosen branch ; the 
physician does not boast of perfection and the attainment of the 
highest goal ; the accoucheur knows there is room for improvement 



1 86 MEDICAL SOCIETY OF NEW JERSEY. 

in the treatment of the pregnant woman and her unborn child ; the 
pathologist is constantly struggling with the problems of his depart- 
ment and day by day shedding light upon some hidden truth, and so, 
gentlemen, does the gynecologist feel proud of the laurels he has 
won, the advancement he has made, the lives he has saved, the sor- 
row and sickness he has relieved, the place of honor he has gained* 
and the recognition he has received before the eyes of the medical 
world. 

If you or I were compelled to have the benefit of competent advice, 
we at once seek our professional brother who is best skilled in that 
special branch under which our case may fall. It is, indeed, the 
admonition of the anxious parent, relative or friend that such should 
be the choice. .There is a sacred duty placed upon us, a trust that 
knows no bounds and a life that must be saved. We fail in the 
honorable discharge of that duty unless the patient is given the 
benefit of the most skillful mind that can be found. 

A man is masterful in a chosen subject only as he is cognizant of 
every particular, proficient in every branch, possessed of every aid 
which might assist him in the perfect performance of his work, 
acquainted with the entire range of special thought which will enable 
him to decide the proper course to pursue, and above all, endowed 
with that innate knowledge which is peculiar to birth and which has 
been gained by years of study and followed with ceaseless activity 
until it has secured for him a broad foundation of learning which 
alone fits him to occupy a place in the front rank of his chosen 
profession. 

Untiring labor is the price of perfect success. Constant activity 
and continued application with intelligent discretion are among the 
necessary requirements of the successful surgeon. 

The greatest surgeon is not he alone whose records can show the 
longest score of operations done, but he who, with the experience 
gained from investigation and operative work is enabled to deal 
intelligently and successfully with disease and honestly and impartially 
with his fellow-men. Thus alone he becomes a master of his art. 

As such will we be judged and accordingly will our recompense be. 

REFERENCES. 

1. Keating & Coe, Clinical Gynecology. 

2. Thomas & Munde, Diseases of Women. 

3. Park, An Epitome of the History of Medicine. 

4. Jones, Gynecology. 



CASE OF AMOiBA COLI DYSENTERY, 1 87 

5. Bennet, Inflammation of the Uterus, 1845. 

6. Sims, Uterine Surgery. 

7. Tait, Diseases of Women. 

8. Wells, Abdominal Tumors. 

9. Thornton, Abdominal Surgery, Past and Present. 

DISCUSSION. 

Dr. W. F. Faison, of Jersey City.— There is very little left for me 
to say. The general surgeon maintains that there is no place left 
now for the gynecologist, but I dissent from this opinion, although no 
one should attempt gynecology until he has spent years in general 
practice. I grant that the surgeon can do a laparotomy and remove 
the tubes and ovaries after he has been told by a gynecologist that 
such an operation is necessary. This is the point I wish to insist 
upon. I have seen the general surgeon repair a laceration of the 
cervic beautifully, but he left a large quantity of scar tissue behind. 
Similarly, he may close up a perineum externally, but not give the 
needed perineal support. 



Report of a Case of Amceba Coli Dysentery. 

BY PHILIP marvel, M. D.. ATLANTIC CITY. 

History— \n 1859, at Prague, Lambdl drew attention to the pres- 
ence of amoeba in the intestines, the case under observation being 
that of a child suffering from dysentery. 

In 1870, Lewis and Cunningham, observed numerous amceba in the 
stools of cholera patients in Calcutta. But it was not until 1875 that 
the parasite, as an etiological factor of dysentery was determined 
by Losch. He succeeded in exciting in a dog, by rectal injections of 
fecal matter, containing amceba, ulcerous lesions of the large intes- 
tine, and verified the presence of the amoeba in the dejecta of the 
dog> eight days after the last injection. 

Kertulis, from 1881 to 1895, while practising in Alexandria, had an 
opportunity to study hundreds of patients ; he observed and verified 
by the post-mortems, the presence of the parasite in more that five 
hundred cases, not only in the feces of dysentery, but in the pus of 
abscesses of the liver ; on the surface of the ulcer and in the walls of 
the abscesses. He failed to find the amoeba in other affections of the 



1 88 MEDICAL SOCIETY OF NEW JERSEY. 

intestine, whether ulcerous or not, and s^cceeded in cultivating the 
parasite in an infusion of sterilized dry straw, and twice provoked the 
disease in cats by inoculation of these cultures. Since then, these 
observations have been verified by other men, who produced the 
disease in dogs and cats, by injecting into the rectum fecal matter 
containing amoeba. 

Bacteriology— T\it dimension of the amoeba vary ordinarily be- 
tween fifteen and thirty-five micromillimeters ; the body composed of 
two parts, is divided into an outer portion, composed of a clear, 
homogeneous substance, and an inner, highly refractive, containing 
vacuoles of greater or less size. When in motion the amoeba is 
characteristic. The movements, sometimes slow, and at other times 
rapid, consists of a progressive motion, but more strictly speaking in 
the thrusting out and retraction of the pseudopodia. 

Growth — The amoeba live in damp grounds or in water charged 
with organic matter, and their activity is greatly dependent upon the 
physical conditions of the media in which they live. When dry, they 
become inactive, and await more favorable conditions, which are 
brought about by a liberal amount of moisture ; hence humidity and 
the absence of sunshine most favor their development, and, therefore, 
it is easy to infer that they may enter the human organism, or that of 
the lower animals, either by food or drink. They feed and multiply 
by division. 

Metastasis Some authors affirm that for the amoeba to reach the 
liver, they must have penetrated through the walls of the intestines, 
passed along the peritoneum and subsequently burrowed through the 
peritoneum and Windslow's capsul. However, it seems much more 
likely, that they reach the organ through the portal circulation, and 
in support of this opinion, is the fact that they are frequently met, 
not only in the walls, but also in the interior of the blood vessels. 

Pathological Anatomy — The lesions produced by the amoeba coli. 
are usually, but not always, found in the large bowel, where the 
ulcers are not the superficial flat ulcers of ordinary dysentery, nor is 
the diffuse inflammation present. The intestinal ulcers of amoeba 
dysentery are characteristic, and are described by Councilman and 
Lefleur, as usually causing a nodular projection containing small 
cavities filled with gelatenoid pus. These cavities open upon the 
mucous membrane by means of a small orifice or sinus tract through 
which pus may be squeezed, which pus always contains the amoeba 



CASE OF AMCEBA COLI DYSENTERY. 1 89 

in varying quantities. These ulcers are usually in the transverse or 
descending colon, but the lesion, however, may exist as an ordinary 
sloughing ulcer, or one with undermined or smooth edges and base. 
The microscopic changes found from scrapings at the edges of the 
ulcer, consist in dilitation of the capillary blood vessels, degeneration 
of the glandular cells, together with an infilieration of leucocytes. 
No fibrinous exudate is found on the surface in these ulcers. The 
submucous coat around the ulcer is also generally infiltrated with 
newly formed connective tissue cells, and the central purulent cavity 
containing pus cells, granular debris, bacteria, small round lymphoid 
cells, and large connective tissue cells. In the most usual form of 
ulcer, the characteristic change will be the folding over or the folding 
in of the mucous membrane, almost covering the ulcer and allowing 
only a small opening on the surface. Numerous nodular figures are 
also present, showing active proliferation of the epithelial cells. 
Therefore, it will be seen that the most intense change takes place in 
the membranous coat. The amoeba are most numerous in the con- 
tents of the abscesses and stools, but are also found in the tissues of 
the mucous membrane, the muscular coat of the lymphatics, and 
thrombosed blood vessels. Councilman and Lefleur believe that the 
primary action of the amoeba is the formation of granulating tissue, 
and that when real pus forms, it is due to a secondary infection. 
With this brief reference as a preliminary, I have the following case 
of amoeba coli dysentery to report : 

Case No. i. — In July, 1902, I was called to see Mrs. C, a resident 
of the north-western part of ^our city, whose history is, briefly, as 
follows : 

Born at Mays Landing, New Jersey. Age 35. Married eighteen 
years, has four children, no miscarriages. Reports previously normal 
menstrual flow, beginning during the twelfth year; now slightly 
irregular, and lasts about seven days. Some pain preceding the flow, 
gradually abating as the same advances. No leucorrhoea. 

Previous General History. ^Sh^ has had the usual diseases of 
childhood without sequella ; had pneumonia about thirteen years, and 
la grippe seven years ago. Circulatory and respiratory organs appar- 
ently normal. The digestive functions have been and are now at 
times slightly impaired. Was curetted in August, 1902, to which 
reference will be made later. 

Family History. — Grandparents died in advanced years. Grand- 



190 MEDICAL SOCfETT OP KBW JERSEY. 

father on maternal side died of cancer. Father dead, cause unknown. 
Mother, three brothers and two sisters living and well. When the 
patient was first seen her condition was slibstantially as follows : 

Deep pelvic pain in the left inguinal region, radiating in the direc- 
tion of the descending colon, aggravated at intervals by paroxysms 
that were exhausting and almost unbearable, except when relieved by 
anodyne. Temperature loi. Pulse 90. Respiration 24. No notice- 
able distension of the abdomen. No diarrhoea nor special manifesta- 
tion beyond the presence and localization of pain, pointing to the 
nature of the disturbance. On the day following there occurred a 
uterine hemorrhage of moderate severity, which was readily controlled 
by vaginal packing. The following day after the removal of the 
tampon, examination revealed a mass which appeared to be in the 
left broad ligament, or adjacent thereto, about the size of a small egg. 
This mass was tender, painful on pressure, and gave to the touch the 
suggestion of fluid. A slight uterine flow or bloody discharge con- 
tinued for some time thereafter, though not sufficiently free to require 
further tamponing. On the fifth day of the disease, the nurse called 
my attention to a vaginal discharge, largely of pus, and also, to the 
fact that there had simultaneously occurred a disturbing diarrhoea, 
with tormina and tenesmus, accompanied by acute pain in the rectum. 
The stools were semi-liquid and liquid, frequent, and shortly became 
dysenteric. Owing to this complication, no vaginal or uterine exam- 
ination was made at this time to determine the source of the pus. As 
to the condition involving the rectum, it was first regarded as an 
acute proctitis, possibly the result of local infection. Its behavior, 
however, soon forced me to regard it as an attack of acute dysentery, 
and the treatment was instituted accordingly. The treatment, as is 
ordinarily employed in such cases, was continued for some weeks, 
with special care to the diet, sanitation, etc., but the results were in 
no wise satisfactory, nor relieving to the patient. The case grew, in 
some respects at least, at times more aggravated; however, there 
came a time when a favorable change took place, but not until after 
the patient had undergone a uterine curettment. 

During the period intervening from the date of the hemorrhage to 
which reference has already been made, until the present date, vis,, 
August 17th, 1902, there continued a colored uterine discharge. 
This, in addition to the dysenterical discharges, was both distressing 
and debilitating to the patient, hence one reason for the operation. 



CASE OF AMOEBA COU DYSENTERY. I9I 

It was noticeable at that time also that the mass attached to the 
broad ligament had largely disappeared, probably safely discharged 
itself through the uterine canal, as pyosalphinx are known at times to 
do. Simultaneously with the c'urrettage it was also noticed that the 
dysenteric discharges suddenly ceased and the abnormal and per- 
. sistent activity of the bowels during the preceding week had become 
as fixedly constipated as they had hitherto been diarrhceal or dysen- 
teric. Just what relation the currettage— that is to say, the influence 
upon the nervous system — the anaesthesia and shock of the operation, 
together with the patient's apprehension, bore to this condition, to 
say the least, is exceedingly interesting and is a subject worthy of 
further thought and investigation, but the time allotted to'this report 
will not permit of further reference upon this point. 

At or about this time I made a proctoscopical examination of the 
rectum with electric illumination, which revealed an ulcerated area on 
the anterior part of the rectum, about two to two and one-quarter 
inches within the external sphincter. The ulcer, as near as could be 
made out, was about three-quarters by one and a quarter inches in 
diameter. The surface appeared cedematous. and somewhat angry 
looking, with slight elevations which were partly covered with mucus 
and mucoid debris, whilst others were clean and very finely granular. 
The ulcerated area was so sharply defined from that of the adjacent 
mucous membrane as to suggest' a secondary manifestation of specific 
disease , however, considering the special history of the disease which 
had preceded this examination, as well as the negative one obtained 
when the general examination was made, I continued the treatment 
for the previously supposed trouble, namely, that of acute dysentery. 
After the aid of stimulating laxatives, such as oil, cascara with nux 
vomica, etc., the bowels gradually again began to discharge without 
assistance, and so continued with only an occasional need for further 
laxative administration. Various caustic and sedative applications 
were from time to time made to the ulcer in question, but little or no 
reparative progress was obtained in the local disturbance ; yet there 
was one feature in the case that was encouraging, vt's,, the slow but 
steadily taking on of flesh and increasing of strength : this, together 
with her age and the healthy condition of her blood, as was noted by 
a differential count, enabled me to exclude a possible malignancy. 
Even this, however, did not prevent discouragement and apprehension 
as to whether or not I might be wrong as to the true nature of her 



192 MEDICAL SOCIETY OF NEW JERSEY. 

disease ; therefore, after about four months' treatment, with the result 
as above stated, I communicated with Dr. John Clarke, of the Uni- 
versity of Pennsylvania, and obtained his consent to assist me in a 
more thorough study of the case, and, if possible, to determine with- 
out further delay the true cause of her illness. Accordingly, arrange- 
ments were concluded, and she was taken to the University Hospital, 
where, after her admission. Dr. Clarke made an examination, a report 
of which is herewith attached. 

December 6, 1902. 

Examination made under ether by Dr. John Clarke, reports as 
follows : 

In the vaginal fourchette there is a small fistula of such small 
calibre as to barely admit a fine probe ; this leads backwards into 
the rectum. The cervix is slightly enlarged, but normal. The uterus 
is normal in size. Marked induration in the left broad ligament. 
Tubes and ovaries normal. No serious pelvic lesion. Rectal 
examination with the electric proctoscope reveals an ulcerated area 
on the anterior rectal wall. This does not bleed readily and does 
not present any evidence of malignancy. Temperature and pulse 
normal. Cultures made for possible dysentery. Ulcer was curretted 
and pure carbolic acid applied to it. 

Treatment — She was ordered a suppository of ichthyol daily and 
the rectum was irrigated with protargol (1-500) every day. 

Bacteriological Report of the Scrapings. — Agglutination test with 
patient's blood and stock cultures of B. dysenteris was positive — 
perfect clumping occuring in twenty minutes with low dilution. 
There was actual bacteriolusis in less than four hours with dilution 
I to 25. Hanging drops sealed and kept for three days exhibited no 
tendency of the clumps to break and grow. Used as control with the 
typhoid bacilli, which was negative throughout, at no time was there 
even cessation of motility. As in the above, hanging drops were 
sealed and kept for three days, at the end of which time the typhoid 
bacilli had grown into a seething mass. 

The colon bacilli isolated from the case were negative to the 
patient's blood. 

Sixteen plates were inoculated and the B. dysenteriae appeared after 
forty-eight hours' incubation. There were sub-cultures made which 
gave positive agglutination reaction with the patient's blood, and 
anti-dysentery serum corresponded, culturally and morphologically 
with the stock cultures of B. dysenteriae. 



CASE OF AMCEBA COLI DYSENTERY. I93 

December 21st.— Dr. Clarke again examined the rectum with the 
proctoscope and found the ulcer in a clean, healthy condition, with* 
out any apparent dimunition in its size. Fistula remained unchanged. 
Temperature and pulse continues normal Patient discharged to go 
home for a week, December 25th, 1902. Owing to a strong inclination 
to remain at home, which was seconded by her family, and acceded 
to by her husband, she refused to return and continue treatment at the 
hospital. 

From this time until the present, she has been seen at varying 
periods of every day, every second day. and now every third day with 
recently slow, but apparently positive improvement in the local lesions. 
Her general health continues to improve rapidly, and she is at this 
writing heavier than ever before; she is. able to go about wherever 
she chooses, and does the greater part of her household work. 
Though the local condition is noticeably improved, being in measure- 
ments about one-half and three-quarters of an inch or less in 
diameter, less angry looking in appearance, and presenting the 
evidence of a slowly healing ulcer, nothing definite can be stated as 
to the time of the final healing. 

Three microscopical examinations have been made from the swab 
since the early part of February with negative reports as relates to 
the amoeba coli. Whilst the discharges from the bowels are no 
longer characteristic of dysentery, every few days there is quite 
a discharge of jelly-like matter such as is often discharged by hysteri- 
cal patients, with an occasional discharge of a little blood. ' This 
may be explained through the continued congestion and over 
glandular action of the colon and rectum, which occasions the 
mucoid secretions, and this lying in juxto position with and passing 
over the ulcer becomes colored with the free discharges from 
the same. 

My apology for reporting a single case of this disease, and that 
before its entire recovery, is embodied in the following suggestions, 
which seem to me to be of more than casual interest, and which may 
be summarized briefly as follows : 

1st. The very small number of cases reported up to this date from 
the eastern and north-eastern portion of the United States, and its 
probably more frequent occurrence than is recognized. 

2d. The persistent and stubborn resistance of various and all 
treatments administered for a period of several weeks, and subse- 

13 



194 MEDICAL SOCIETY OF NEW JERSEY. 

quently, the very slow yielding of the local lesions to continued 
direct and varied applications, for a period of more than five months, 
and this in the absence of the amoeba coli, so far as microscopical 
study of the discharge revealed. 

3d. The very rapid and satisfactory progress in the patient's 
general health for the corresponding period, which would seem to 
indicate the very slight influence of the local lesion remaining, after 
the disappearance of the amoeba, on the patient's general or systemic 
forces, emphasizes the importance of a correct early diagnosis of the 
disease, a more familiar acquaintance with the specific cause and 
differential symptoms, and a knowledge of a more speedy treatment 
of the local lesion than the writer has been able to find. 

DISCUSSION. 

Dr. Judson Daland, of Philadelphia. — The case reported is one 
of considerable interest, because such cases are not numerous in this 
part of the country. Amoebic dysentery is particularly interesting 
because of its close association with this special parasite, an organism 
which is fortunately rather easily discovered in the fecal discharges. 
The demonstration of the presence of this amoeba is necessary for 
the diagnosis. Its relation to ulcerative processes in the colon has 
been brought out thoroughly in the paper. A very interesting point 
in the relationship which it bears to the ulcers is that often there are 
also prfesent the micro-organisms of suppuration. I have been partic- 
ularly interested in the association of various hepatic disorders with 
this form of dysentery. This explanation of multiple hepatic abscesses 
is one of the most interesting in the study of the causation of disease. 
It is believed that the amoeba includes within itself these various 
organisms of suppuration, and that they are swept along in the blood 
current and lodge in the liver. Here begins a new focus of suppura- 
tion, thus explaining many cases ofabscessof the liver occurring more 
especially in the tropics, which would otherwise be inexplicable. 

The cases presenting themselves in Philadelphia for observation are 
few. I have been particularly interested in the chronicity of the ulcer 
in the case reported. It is quite possible that the ulcer discovered in 
this patient is not the only one present, and that there are others 
higher up beyond the field of vision. Fortunately the ulcerations are 
not usually deep, and perforation is not very common. We can, 
therefore, treat these cases topically by means of enteroclysms. Some 
benefit in these cases may be derived by the use of quinine solution. 



CASE OF AMCEBA COLI DYSENTERY. 1 9$ 

We all know the effect of quinine on the parasite of malaria, which is 
also an amoeba, and it has been proven quite conclusively that quinine 
exerts its beneficial influence particularly when the amoebae are free 
in the blood and are not confined in the corpuscles, showing that it is 
the direct action of the solution of quinine in the blood. I would 
suggest that the colon be thoroughly washed out and then a solution 
of quinine be brought in contact with the ulcer. I have also used 
injections of a dilute solution of hydrogen peroxid. 

Dr. Philip Marvel, of Atlantic City.— I wish to correct a false 
impression conveyed by my paper. I have learned that some of the 
gentlemen present understood the curettage to be a curettage of the 
bowel. This was not the case ; it was a curettage of the uterus, and 
the operation had no connection directly with the dysenteric disease, 
and was employed simply for the accompanying condition requiring 
treatment. It was only referred to because there was a pyosalphinx 
complicating the trouble, and the condition continued throughout 
the earlier part of the disease, though finally rupturing and discharg- 
mg itself. The resulting endometritis was what demanded curettage 
of the uterus. The effect of this operation on the general condition 
of the patient was really wonderful, and its action on the dysenteric 
discharges was also very decided. Quinine was not used locally in 
this case, but it was administered internally. The reason for this 
was that Dr. George Dock, of Ann Arbor, had reported a case in 
which he had used a solution of quinine, varying in strength from i 
to f ,000 to I to 500, for a considerable time in a case under his obser- 
vaiion without any satisfactory results. The same investigator also 
made use of benzozol without any apparent beneficial effect. I am 
not aware of any topical applications that have been used with special 
benefit upon the local lesions. The cases which have been reported 
in the east and northern portion of the state have been from Philadel- 
phia, Baltimore and Michigan. Dr. Dock seems to have followed 
his case with special care for a period of over five months. The 
patient finally left him with the amoeba still present in the stools and 
scrapings, and with the ulcer unhealed. The cases at the Johns Hop- 
kins hospital were possibly more favorable, but a long time was 
required for the healing of the ulcers. The chronicity of these cases 
is certainly very great, and we are not prepared to say at present 
how long they last. In my case, the ulceration continues in spite of 
the fact that we are unable to find the amoeba present in the stools 
or from cultures made from swabbing the ulcer direct. 



196 medical society of new jersey. 

Osteopathy. 

BY DANIEL STROCK. M. D.. CAMDEN, N. J. 

This short paper is prepared with the object of giving the members 
of this Society some idea of what osteopathy is, and what claims are 
made for the system by its votaries, as there is much misunderstand- 
ing of the subject, even among the medical profession. 

The word is compounded from osteon (a bone), and pathos 
(suffering). 

The various journals and announcements published in the interest 
of this so-called school of practice point with pride, evidently, to the 
fact that the word also has a legal definition, as by statute of the State 
of Missouri it is declared to be '*a system, method or science of 
healing." Other states, as North Dakota, Iowa, Michigan and 
Vermont have given the word a legal definition and the system a legal 
status. 

This method of curing disease is claimed to have been "discovered " 
in 1874. by a gentleman of Kansas. The discoverer reasoned that 
" A natural flow of blood is health, and disease is the effect of local 
or general disturbance of blood — that to excite the nerves causes 
muscles to contract and compress venous flow of blood to the heart ; 
and the bones could be used as levers to relieve pressure on ner\'es, 
veins and arteries." 

"Osteopathy is a system of treating disease, without drugs, by the 
use of the hands to adjust all parts of the human mechanism to 
perfect mechanical relations. It is that science which finds in dis- 
turbed mechanical relations of the anatomical parts of the body the 
causes of disease, and which is employed to cure disease by apply- 
ing technical knowledge and high manual skill to the correction of all 
disturbed relations occurring in the mechanical arrangement of the 
body. It is a science founded upon the principles of anatomy and 
physiology. 

" The word osteopathy does not mean the treatment of bones, nor 
of bone diseases. It was used as a name because the founder dis- 
covered the importance of disturbances in the bony framework of the 
body in causing disease. He studied the skeleton as the foundation 
of anatomy, upon which science he grounded his system. The mean- 
ing of the word applies not only to derangements of the bony parts, 
but as well to disturbed relations of ligaments, tendons, blood vessels, 
muscles, nerves and of any body tissue." 



OSTEOPATHY. I97 

They are committed to the doctrine that " Mechanical displacements 
and pressures are the great causes of disease ; the pressure caused 
by a slightly slipped vertebra, a contracted muscle or an over-devel- 
oped ligament, acting upon blood vessels, to lessen blood supply and 
nutriment to a part, or to cut off the nerve influence.** 

The deplorable condition of the patients who come under the 
observation of the practitioners of this method of treatment, and the 
miraculous cures effected, are best described by quoting from a paper 
read at one of their conventions held recently. The writer of the 
paper had evidently discovered more than one " new disease," but he 
was equal to. the occasion in every instance, as it isn't recorded that 
any of the patients got away from him uncured. 

Case A. — " Retroflexion following childbirth. Treatment was 
applied to correcting slipped innominates, both of which were up and 
back.'* 

This case illustrates the importance of getting hold of this class of 
injuries before they have had an opportunity to sit down hard ; whereby 
they incur the risk of pushing the innominate bones up in the axillae, 
thus greatly complicating the treatment. 

Case B, — " Miss A, troubled with very painful periods ; anteflexion. 
Entire lumbar region was posterior. Second lumbar vertebra turned 
to the right ; fifth sensitive. Treatment consisted in correcting the 
spinal irregularities." 

Evidently the favorable condition in this case was that the second 
lumbar vertebra did not turn to the left. How often patients are 
ignorant of the providential interventions in their behalf. 

Case C— " Miss M, leucorrhoea ; sacrum tilted backward. Treat- 
ment : Adjusted sacrum." 

The lesson taught by this case is, if the condition had not been 
discovered, that sooner or later the young lady would have doubled 
up like a jackknife, if engaged in the performance of some of the 
natural functions of the body, particularly while strolling in the 
country, or at a picnic. 

Wonderful as these cures are, and related with such self-complacency, 
we can yet imagine the chagrin of this reporter when he learns how 
skilled are the osteopaths of California. I am informed by a medical 
colleague who had recently returned from that State, that, in a con- 
versation with an osteopath, the latter assured him that he had cured 
a case of displacement of the odontoid process amounting to at least 



198 MEDICAL SOCIETY OF NEW JERSEY. 

a half-inch. After prolonged treatment, the individual recovered. 
There is no history that this patient had been hanged, but the case 
shows how, in the future, judicial mistakes of this character may be 
rectified under osteopathic auspices. 

These are a few examples of the conditions claimed to be found by 
osteopaths, under their superior methods of examination. Apparently, 
they experience no difficulty in detecting these enormous bony dis- 
placements, notwithstanding they have escaped the observation of all 
other physicians, and are of a character to produce either instant 
death or complete loss of the power of locomotion. But it is not for 
such disabilities these patients receive treatment, and have their ver- 
tebrae, the sacrum and os innominatae replaced ; the attention of these 
skilled diagnosticians are directed to these great deformities only 
because they find a retroflexion, an anteflexion, or painful menstrua- 
tion. Having discovered these minor irregularities of the female 
sexual organs, then they know where to look for the cause, and 
apparently they readily find it ; particularly if they have a credulous 
patient. And judging from the reported cases, many of their patients 
are of that class. 

Even a case of indigestion suggests to them the necessity of ex- 
amining the vertebral column for luxations, and the search is 
invariably successsul, according to the statements made by writers 
in the journals devoted to the dissemination of knowledge of this 
wonderful "system, method or science of healing." It is quite evident 
that no patient need depart from the presence of an osteopath with- 
out knowing exactly what is the cause of his illness, even though it be 
nothing more gross than a slight turning of a vertebra to the right or 
left. In fact, it is the detection of the minute displacements of the 
bones of the vertebral column that constitutes the "strong holt " of 
the osteopathic professor. We can imagine with what fine scorn, 
even though it be unexpressed, he listens to the young man who tells 
of finding the innominate bones up and back, or the whole lumbar 
region posterior, or the sacrum tilted backwards. It must seem to 
him that even osteopathic babies would be equal to the discovery of 
such immense lesions of the human body. And how crestfallen and 
despairing must the enthusiastic young man become, when subse- 
quently he hears the professor relate the histories of numerous cases 
of dyspepsia, of diarrhoea, of appendicitis and other diseases he has 
cured, by first detecting the *' slight displacement of the vertebra " 



OSTEOPATHY. I99 

that was the cause of the symptoms. We can imagine the young 
man» in self-communion, wondering how he can ever hope to attain 
the skill that will enable him to detect a misplaced odontoid process, 
or a •* slight " slipping of a cervical, dorsal or lumbar vertebra — a 
*' slipping " so little that the sum thereof is represented by the 
smallest fraction of an inch, a la th6 professor. 

And it is evident that this young man. if hopes to become a suc- 
cessful osteopath, must become thus skillful ; that is, skillful enough 
to make his patient believe that any of these lesions are found upofi 
his person. 

After having found the cause of the disease, and we will presume 
the patient has appendicitis, '* the osteopathic method of treating these 
troubles is by manual manipulation, to correct this physicial cause. 
This is not done by massage or Swedish movements. If a verte- 
bra is out of place, it is replaced by using the arms and legs as 
levers.'' Exactly on the principle, we presume, that a mechanic 
might attempt to move a building by swinging its doors— and with 
exactly the same result. 

The advertisements of those who modestly claim to be "recognized 
specialists " in osteopathic treatment, states that all chronic diseases 
are treated, and that " eighty per cent, of these we cure outright ; 
ninety per cent, we greatly benefit." While no mention is made of 
curing smallpox, or even soliciting cases to treat, yet there is evidently 
great confidence in their ability to treat diseases of the female sexual 
organs, and their advertisements vie with similar ones to be found in 
certain newspapers of our large cities. 

One of the advertisements diffidently says : " While it is not cus- 
tomary to advertise osteopathy," yet enumerates fifty-seven diseased 
conditions treated by this method, among which are " uterine affec- 
tions, vaginal affections, female irregularities, suppressed or excessive 
menstruation and leucorrhcea." 

There is one feature about osteopathy that must commend it to 
individuals of a certain class ; that is, that it isn't particularly difficult 
to become an osteopath. One college advertises that the minimum 
qualification for entrance to the course is a " good common education 
and average natural ability " ; and after this difficulty of admission is 
overcome, the student is permitted to take the course, which " covers 
two years." 

Another commendable feature, which must also appeal strongly to 



200 MEDICAL SOCIETY OF NEW JERSEY. 

the class of individuals mentioned above, is the evident elimination of 
the sentimentality that has been in vogue during the past in the treat- 
ment of the diseased and dying. Business principles alone must pre- 
vail, as is evident from statements made in a college announcement, 
that " there is, perhaps, no profession at the present time that offers 
facilities for so quickly acquiring financial independence as that 
offered by osteopathy. * * * Conservative professional minds, 
those competent to judge, declare that the future possibilities of osteo- 
pathy, in a financial way, are unsurpassed. ♦ + ♦ Two of the 
business principles of its success are. the fee of practitioners is 
everywhere just the same ; the universal practice of osteopaths is to 
require pay in advance." 

Evidently, these appeals to that industrious class, who want some- 
thing easy to do. do not fall upon unheeding ears, judging from the 
number of so-called colleges of osteopathy that are blossoming 
throughout the country, and bearing fruit — such as it is. 

The legal standing of a practitioner of osteopathy in this State is a 
matter of interest to all regular practitioners, and, until recently, it 
was an unsettled point. But the honorable Wilbur Heisley, presiding 
Judge of Monmouth Quarter Sessions, so clearly interpreted the stat- 
utes bearing upon the practice of medicine in New Jersey, during the 
trial of a cause before him, that, without doubt, subsequent efforts to 
influence the Legislature in the interest of osteopathy is directly 
traceable to that decision. 

The learned judge said : '* The thirty-fourth section of our statutes 
seems to prohibit any one from practicing the healing art under any 
system unless he has first passed an examination and received a 
license. Apparently, the Legislature meant the inhibition to apply to 
all systems of any kind, not alone to systems or schools of medicine 
or surgery in which drugs are used or surgical operations are per- 
formed ; because the last clause of the thirty-fourth paragraph pro- 
vides that the provisions of this act shall apply to all persons 
professing and attempting to cure diseases by means of the so-called 
system of faith curism, mind healing, laying on of hands, and other 
similar systems." I do not find a similar clause in the statutes of any 
other State, and am obliged to believe that the Legislature deemed 
the subject of such vast importance that no one should be permitted 
to administer and prescribe as a practice for the curing of disease 
unless with the permission of the State Board of Medical Examiners, 



OSTEOPATHY. 201 

and that this board was to be the sole judge of any and all systems 
and of the fitness of the person to administer to the sick. 

" This defendant did advertise himself as a physician for the curing 
of * nervous and chronic diseases.' He thus called attention to the 
fact that he was able to treat as a physician the sick, and it seems to 
me that the question of what system or school he followed is a matter 
of no moment, because, under the statute, as I interpret it, he had no 
right to practice any system whatever, medical or religious, such as 
the laying on of hands, without a license. I find the defendant guilty, 
as he stands charged in the indictment." 

This decision closed the doors of this State to Aie osteopath, if any 
one would enter proceedings in the courts against him ; and, as a 
result, during the last session of the Legislature a bill was introduced 
having for its object the legalizing of this method of healing. The 
bill was defeated in committee, largely through the unanswerable 
arguments of the President of this Society. The attempt having been 
made to legalize this '* system ** of medical practice, it behooves the 
profession of the State to be alert, as the advocates of the measure 
have simply retired, and may be expected to renew the attack. 

In conclusion, the objections to osteopathy may be summarized as 
follows : 

It is not a system of medicine or surgery. 

The instruction imparted to its practitioners is inadequate. 

There is no reason why one of the minor agencies of practice should 
be dissociated from general medicine. 

To legalize it would afford unscrupulous individuals the opportunity 
to suppress the evidence of their incompetency by writing a death 
certificate. 

DISCUSSION. 

Richard Cole Newton. M. D.— In the early 7o*s, General 
Stewart L. Woodford brought to Brooklyn, N. Y., an Italian woman 
called Madam Dolchivi, whom he had met in his travels and who had 
treated his daughter, then suffering from hip disease. This woman, 
it is alleged, could neither read nor write, nor could she speak a word 
of English. Her fingers were covered with rings and she was at this 
time an old woman, perhaps seventy years of age. She treated 
diseases by manipulation and rubbing, and she had done so for a 
number of years ; claiming that she had discovered from manipulat- 
ing animals, that diseases might be due to sKght displacement of the 



202 MEDICAL SOCIETY OF NEW JERSEY. 

bones, and that by her treatment, she restored these bones to their 
proper relations with the surrounding parts, and thus cured the 
diseases. She also claimed to have an extremely delicate, or highly 
developed, sense of touch, by means of which she was able to discover 
and correct the alleged slight displacements or malformations of the 
bones and their surroundmg tissues. It is alleged that on account of 
her remarkable success in the treatment of disease, she was accused 
of being a witch, and had been imprisoned for witchcraft or necro- 
mancy three times in Europe. She opened an office in Brooklyn, 
N. Y., in, I believe. Gates avenue, and practiced* there for a time, 
about 1876, treating a large number of patients. 

Here then we have, gentlemen, the practice of the so-called 
science of osteopathy, at least several years before its alleged dis- 
covery by •• Dr." Still, which Xht Journal of Osteopathy informs us 
was in 1874. Norman D. Mattison, D. O., informs us that " the 
science of osteopathy was discovered by Dr. A. T. Still, of Kirksvillc. 
Mo., in 1874. The original discovery was only the principle, its de- 
velopment required years of research, study and experiment. Dr. 
Still's first students were his sons when he began teaching in 1887. 
The American School of Osteopathy, at Kirksville, Mo., was founded 
by Dr. A. T. Still, and was chartered by the State of Missouri in 1892.*' 
There is no question, then, that the *' system " was not the invention 
of A, T, Still as claimed, and there is little probability that the 
ignorant Italian woman, brought to this country by General Woodford, 
was the founder, discoverer, or originator of tlris system. Both 
Madam Dolchivi and " Dr." Still probably learned this interesting 
theory from a common source, and a sufficient amount of time and 
trouble spent in following up this clew would doubtless reveal the 
true author of this system of treating disease. Even as Hahneman 
was not the true author of the celebrated doctrine expressed in the 
dictum "Similia, similibus curantur," so Still is not the true author of 
osteopathy, and inasmuch as he claims to be such, he is an impostor 
and unworthy of credence. 

As Dr. Bodine testified in the well-known case. Nelson vs, the 
State Board of Health of Kentucky, "Osteopathy is the ne plus ultra 
of absurdity,'* 2Ji6. the testimony in that case showed beyond all room 
for doubt, that the school at Kirksville was entirely inadequately 
manned, endowed or equipped for the teaching of any sort of physic- 
ians or surgeons to whom the care of human life might be intrusted. 



OSTEOPATHY. 203 

That anatomy, the alleged stronghold of the osteopaths, has never 
been taught there by dissection, and demonstrations on the cadaver, 
the only reliable or effectual method of teaching this difficult branch, 
which the osteopaths claim as the principal bulv^rark of their system, 
just as it is without doubt the foundation stone of honest medicine. 

The testimony in the case above alluded to. showed that " Dr." 
Still had claimed to have graduated from a medical school in Kansas 
City in the '40's. when no medical school was carried on at that place 
in those years. 

Of the fourteen teachers of the school of Kirksville, only one 
wrote M. D. after his name, and he was at that time under indict- 
ment for felony in at least two different states. Examination into the 
educational claims of the graduates of this institution, will probably 
reveal that their education is of the crudest sort, and as someone has 
said of their practice, they are only masseurs, and not first-class ones 
at that. 

How does it happen then, that they have achieved so considerable 
a measure of success } They have received a legal license to prac- 
tice in eight or more states. They are practicing with more or less 
success in many states and claim to be constantly growing in numbers 
and increasing in influence. A number of other schools besides the 
one in Kirksville. Mo., have started up. Of the numerous irregular 
systems or methods of practicing medicine, which have been started 
in recent years, this would appear to be the only one that has 
achieved much vogue with the people. Probably Eddyism has 
more converts in the east than osteopathy. But this is the only 
system of treatment, or rather non-treatment, which can be said 
to rival osteopathy in the number of its dupes. The question 
that most interests us is the practical one. Why have these unlettered 
and ignorant men and women, professing an absurd and impos- 
sible theory of practice and claiming to do what no one can do, even 
if he has a touch so acute that he can detect a human hair under 
twenty sheets of paper, as we are told these charlatans have learned 
by long practice to do — why, I say, have they succeeded as well as 
they have? 

I have no hesitation in answering that it is because they have been 
able to help a large percentage of those who have applied to them 
for relief. A short consideration of their modus operandi and its re- 
sults may not be uninteresting, and I think we may learn something 



204 MEDICAL SOCIETY OF NEW JERSEY. 

from studying their methods. Ambrose Pard did not dislike a quack 
if he could learn something from him. A recent writer has said 
** Nothing is more characteristic of fruitful men than their ability to 
take suggestions from every quarter." So then, let us not make the 
mistake of dismissing this subject too hastily and failing to discern 
the important kernel of truth in the midst of the bushel of ignorant 
and foolish bombast. 

In the first place, probably all irregular systems of practice have 
more or less that is practically valuable in their application, and this 
system is no exception to that rule. 

Secondly, the public care very little for the theoretical or historical 
aspects of our art. They only concern themselves with results, and 
will go to the worst quack, just so long as they think that he or she 
can help them. 

Thirdly, this so-called system is, so far as the unthinking, public 
goes, as yet entirely novel, and possesses all the charms of novelty. 

And fourthly, it has been pushed with astonishing assurance and 
persistence, and as Pliny observed many years ago, "any one with a 
sufficient stock of impudence may reasonably well pass for a 
physician. 

You may ask me upon what I base my assertion that this method 
of treatment has done good in individual cases. I reply from personal 
knowledge partly and from a considerable accumulation of testimony 
from those who have undoubtedly been benefited by it. It is right 
here that I think the profession may learn something. Cases that 
would ordinarily have received very different treatment are pulled and 
jerked about in royal fashion by the osteopaths. Cases of heart and 
liver disease, of diabetes, rheumatism, neuralgia, etc., that greatly 
need the vigorous manipulation which the osteopaths give them, do 
not get it from us. We may advise exercise, but we do not take the 
time to see it carried out. These gentlemen, however, administer it 
themselves in a liberal fashion. Our gouty lithemic, hysterical and 
neurasthenic patients as a rule hate the word exercise, and carefully 
avoid even the semblance of perspiration. They overload their stom- 
achs and injure their digestions by rich cooking, sweets, wine and 
tobacco, and are too lazy, or too busy, to take the necessary bodily 
exercise. We. if we are honest with them, tell them that their 
troubles are due to their own self-indulgence and must be over- 
come'by abstinence and self-denial, and by exercise, and by promoting 



OSTEOPATHY. 205 

I 

the action of the skin and bowels. How much nicer ! How it saves 

one's amour propre, to be told that the third cervical vertebra has 
slipped and that a certain number of treatments will restore it to place 
and keep it there. Then these practitioners proceed to administer 
the massage that is needed, and some of them, in fact, I dare say. 
the most of them, also make the skin act by hydropathy, or hot air, 
or steam^ or some other mechanical means. It is another example, 
and a striking one, of fools rushing in where angels fear to tread ; and 
the lesson to be learned from it is that we have been too backward 
about ordering and enforcing bathing, rubbing, stretching and rotat- 
ing stiff and diseased joints, and about using these mechanical 
methods in many serious, and more or less incurable and irresponsive 
diseases. 

When Ocrtel brought out his treatment for heart disease by gradu- 
ated hill-climbing, etc.. the medical world was dumbfounded, just as 
they were some years before by finding out that fever cases get well 
more quickly and more surely in tents than in houses, and a few years 
before that, by the discovery that neither food nor water should be 
withheld in fevers as had formerly been done. 

It is our duty to inform the public of the hollowness of the preten- 
sions of these charlatans, and at the same time to acknowledge that 
the massage and the fierce twisting and bending of the joints, to 
which they subject their patients, are good and valuable methods of 
treatment in properly selected cases. 

Numbers of cases of injury from the indiscriminate application of 
this method have come to my knowledge, and there is danger that 
the public, hearing of such cases, may lose sight of the good accom- 
plished, and the system may meet with too sweeping condemnation. 
We should strive to conserve what is good in it, but it had better 
perish from the earth than to be left in the hands of the ignorant 
people who now administer it, and who subject tubercular, rheumatic, 
cancerous and syphilitic and hysterical lesions to the same identical 
treatment. That they have not done more harm is perhaps a wonder, 
but the dead tell no tales, and of the surviving victims of quackery 
that same vanity and weak judgment which lead them to stray away 
from the regular profession will often keep their mouths sealed, 
although they may realize that they may have been duped. 

The quack will always be with us, and many and varied are his 
methods; let us search out the good that we may accomplish and 



2o6 MEDICAL SOCIETY OF NEW JERSEY. 

the reason for it, and if practicable, use it for the benefit of our patients, 
and not be too proud or too narrow-minded to learn from any one. 

The Eddyites, the mind curists, the strict homecepaths, the Dowie- 
ites, etc., demonstrate every day how comparatively well people may 
get along without any treatment except in some cases the mental 
stimulation of being assured that nothing ails them, and their symp- 
toms are only beliefs ; and in others of having solemnly administered 
to them at regular intervals totally inert doses of alleged remedies ; 
while the osteopaths, the hydropalhs, the magnetic healers, etc., dem- 
onstrate plainly enough that certain classes of cases are more bene- 
fited by mechanical therapeutics than by drugs ; while we must 
acknowledge that a wise administration of drugs is our sheet anchor 
in the treatment of most diseases, and is, and probably always will 
be, a far more important and valuable method of therapeutics than 
any other. We also cannot fail to perceive that a heahhy body is one 
that normally performs all of its functions, and that a body in which 
assimilatiom, elimination, metabolism and growth are not normally 
performed is not healthy, and further that any procedure which tends 
to restore these functions to their normal activity is often better and 
more rational treatment than the exhibition of drugs. 

Let us point out the road to perfect health and urge our fellow- 
mortals to walk in it. Let us strive to arouse in them what Herbert 
Spencer so well calls a *' physical conscience." Then, and then only, 
shall we have performed our hij>hest duty to weak and suffering 
humanity. 



Cantwell's Opekation for Complete Epispadia. 

F. V. CANTWELL, M. D., TRENTON. N. J. 

There seems to be some confusion in the use of the words " epispa- 
dia" and ''epispadias." Epispadia is the condition, and epispadias is 
the person suffering. 

Probably no congenital deformity is more distressing than complete 
epispadia, not even exstrophy of the bladder. In childhood the 
sufferer is a constant source of annoyance to the parents; in youth a 
burden to himself, uncompanionable on account of odor, his belly and 
thighs bathed in urine, excoriations occur for which there is no 
relief. In early manhood, when healthy blood courses through the 



OPERATION FOR COMPLETE EPISPADIA. 207 

testicles and vague desires arise in his brain, he grows moody ar.d 
melancholy and avoids company, for he begins to feel that he is unlii 
to accomplish that one act for which he has been ripening. 

It was while in this mental condition that a young man ended his 
troubles by throwing himself beneath the wheels of a locomotive. I 
was called to view his body and found that he had complete epispadia. 
While dissecting his penis I was struck with the ease with which the 
cavernous bodies could be separated, and was led from this to devise 
an operation which has been successful, not only in my hands, but in 
the hands of several others in this country and England. 

The operations described in the text books have all the same draw- 
backs, that the incontinence as a rule remains, and that several dis- 
tinct operations are necessary, thus extending the period of cure over 
months. Thiersch has devised an operation for this condition which 
Billroth calls '*one of the most brilliant in plastic surgery." He 
consumed one and a half years in the cure of one case. Thiersch's 
urethra is part skin. My urethra is made of the mucous membrane 
which nature intended for that purpose. In the operation of Duplay 
several incisions are made into the cavernous bodies near the pubes 10 
straighten the penis. This is unnecessary, for, when my operation 
is confpleted it leaves a pendulous penis. 

It is not my intention to go into the literature of this subject further 
than the cases which I have seen reported of my own method. 

The aim in this operation is to restore the parts to their normal 
relations. To do this is simple. Loosen the urethral gutter com- 
pletely ; separate the cavernous bodies, place the urethra in its normal 
position beneath these bodies and bring them up over it, then with a 
few well applied sutures a normal organ js made. 

It is necessary first to underdrain the field of operation by the 
establishment of a perineal fistula. A finger is inserted into the 
bladder and pushes out the perineum. A few strokes of the knife 
onto the finger suffice. If the opening at the infundibulum is too 
small for the finger a steel sound may be used. In order to keep the 
perineal opening patulous a specially devised drainage tube, or a 
piece of ordinary tube stitched fast to the skin is needful. The ques- 
tion arises whether to operate on the penis immediately or not. There 
is no reason for waiting, except that the ever-present excoriations may 
be aculture bed of bacteria, and so make it impossible to have a clean 
wound. In my own two cases I waited for ten days. 



208 MEDICAL SOCIETY OF NEW JERSEY. 

Where the urethra joins the skin in epispadia there is a distinct line 
of scar tissue on either side. It is along these lines the incision 
should be made to dissect loose the urethra. These incisions should 
be made to join above the infundibulum at the pubes, and are carried 
out to the extremity of the glans penis. They should be as deep as 
possible without injuring the cavernous bodies. Then the whole 
penile urethra should be dissected loose as a flap, having for attach- 
ment its continuation into the bladder. Then the cavernous bodies 
are separated by a blunt dissection, or by light touches with the 
knife. In the normal penis this would be impossible without injuring 
the fibrous envelope covering them. A short vertical incision is made 
in the glans penis. 

Dr. Parham, of New Orleans, suggests that the urethra be cut off 
at its junction with the glans. Then tunnel the glans with a knife, 
or trocar, and draw the urethra through the opening thus made. 
This is a most valuable suggestion in the most difficult part of the 
operation, and the well-known extensibility of the urethra would make 
it easier and I believe better. 

The urethral flap is placed in the gutter between the cavernous 
bodies and held in this position by two sutures through mucous 
membrane and skin tied on the under surface of the penis ; a metal 
catheter is then laid on the urethra and a tunnel is formed by a 
continuous suture of the free edges of mucous membrane above 
the instrument. The corpora cavernosa are brought together above 
this and retained in place by continuous suture. The skin being 
brought together above these, a few well-applied deep sutures are 
taken in the skin and fat of the mons veneris. This leaves a 
perfect penis, with only a line of sutures along the dorsum. 

There is usually free bleeding, but this is readily controlled by 
sutures and pressure. In my own cases I allowed the catheter to 
remain in during the process of healing. I now believe it causes 
swelling, and the bladder can be washed, if necessary, through the 
perineal tube. 

As this condition is a very rare one, there is not much current liter- 
ature on the subject. My own two cases were published in Annals 
of Surgery, December, 1895; since then I have seen four cases 
reported of this operation, and the results have been so good that it 
has led me to the writing of this paper. 

Case I. — Robust boy, aged eleven years, penis showed complete 



OPERATION FOR COMPLETE EPISPADIA. 209 

epispadia ; arch of pubes present, but slender ; parts badly excoriated 
by continual dribbling of urine ; he kept his clothes dry by the use of 
very thick pads of cloth. Perineal fistula made and ten days allowed 
to elapse. The seat of operation was found dry and skin free from 
excoriations. There was free bleeding during operation, but it was 
readily controlled. The urethral flap was unfortunately button- holed 
at the- glans, this afterwards necessitated the use of bougies on 
account of the tendency to contract. The rest of the operation went 
smoothly. There was a great deal of swelling for some days after 
the operation, but this subsided. In three weeks the whole wound 
had closed, with the exception of a pin-hole opening at the site of 
the infundibulum. This persisted for six months in spite of efforts to 
close it, when it finally closed. In August, 1895, fifteen months after 
operation, he had a good penis, which, instead of being drawn up to 
form a cork for an opening into the bladder, hangs pendulous as a 
normal penis does. He can get a firm erection, and, although he 
still dribbles somewhat, he is proud of the strength of the stream he 
passes. He retains his water for more than two hours. He keeps 
dry by the use of the urinal. Since this was written, he has done such 
work as braking on the railroad. He has been married for two years, 
but I have not been able to find whether or not there are any children. 

Case 2. — Sickly boy, aged seven, similar to Case i, except that I had 
attempted a year before to repair his penis by a flap operation, which 
was a dismal failure, and left the penis worse than before. This 
operation was far more difficult, on account of smallness of the penis 
and the fact that the cavernous bodies were poorly developed. The 
child had tuberculosis of hip-joint and did poorly from the beginning. 
August, 1895, s^x months after, although the boy has not a good penis, 
he has a canal to the end of it. He has some control over his urine. 
and at times can pass a stream. He would be dry and comfortable 
with a rubber urinal. 

Case J. — Reported by Herbert W. Page, in the London Lancet, 
November 5, 1898. Boy, aged ten years, was first sent to me two 
years ago by Mr. Havell. of Felixstowe, but it was then decided to 
postpone operation until the parts were somewhat larger, and accord- 
ingly he was admitted again on February 22, 1898. There was 
complete epispadia with an infundibuliform opening above the pubes, 
from which urine was continually dribbling. Nevertheless, there was 
a slight amount of control and the passage of a catheter showed that 



210 MEDICAL SOCIETY OF NEW JERSEY. 

there was a well-formed bladder. It hurt him too much to attempt 
to pass the finger. The penis was small and ill-developed and was 
turned upwards, so that the glans lay over the mouth of the funnel. 
When pulled downward it was seen that the penile portion of the 
urethra existed as a fiat band of bare mucous membrane, reaching 
from the dorsum to the rudimentary glans, back to the bladder 
opening, where it was lost from view. The corpora cavernosa clearly 
were there, but they occupied the under side of the organ. There 
was a good scrotum and both testes were to be found in it. An 
an attack of measles delayed operation until May i8, when as a 
preliminary step an opening was made in the perineum and a 
Watson's silver tube inserted in order that after the plastic operation 
the parts might be kept entirely free from the contact of urine. 
From this time forth, the boy lived night and day in a warm boric 
bath, a procedure which I do not doubt, contributed largely to the 
success of the operation, as well as to his own comfort. The perineal 
tube answered admirably and he never complained of it. The plastic 
operation was undertaken on May 20, and presented no difficulties 
save such as were entailed by formation of the urethra and accurate 
suturing. The urethral flap having been freed from the corpora 
cavernosa on which it lay, was moulded into a tube upon a catheter, 
fine catgut being used for the sutures. The corpora cavernosa were 
separated from each other with singular ease, and their subsequent 
union, together with the fixation of the new urethra in its rightful 
place beneath them, was made with finest silk. Finally, the skin 
along the whole length of the penis and over the infundibuliform 
opening was sutured with silkworm gut. A soft catheter was then 
passed by the natural route into the bladder, secured, and left there. 
Everything went well after the operation, but on May 24 there was so 
much oedema of the scrotum that I made several punctures in it. the 
perineal tube was removed, and one or two of the dorsal silkworm 
stitches were taken out because of obvious tension. The soft 
catheter was also taken out, cleaned and reinserted. More sutures 
were ^removed on May 26, and by June i, the perineal wound was 
healed. Already the child had gained considerable control over the 
passage of the urine, and emptied his bladder at will through the 
retained catheter. He was still kept in the bath. By June 8, the 
retained catheter was discarded and the urine was drawn off twice a 
<lay, not^with the object of emptying the bladder, but of obviating a 



OPERATION FOR COMPLETE EPISPADIA. 211 

tendency to contraction at the meatus. Removal of the boy from the 
bath for a few hours revealed a slight leakage at the infundibulum, and 
accordingly, on June i8» a small plastic operation which need not be 
specially described, was undertaken for the closure of the tiny orfice 
which was alone the cause of it. This was successful, and after a few 
days longer in the bath the child was recorded, on July ist, as being able 
to retain his urine for seven hours, as passing it naturally, and as being 
perfectly dry throughout the day. When discharged on July 7, it was 
able to retain his urine all night, and the only defect, if so it may be 
called, in the result of the operation was a slight tendency to contrac- 
tion of the meatus, for which the daily passage of a catheter was 
recommended. The latest reports of his condition are in every way 
favorable, and he is now regularly at school. 

Case 4. — Reported by Dr. D. W. Parham, of New Orleans, in the 
New Orleans Medical aud Surgical Journal^ for January, 1901. 
Through the kindness of my friend. Dr. E. D. Martin, I had recently 
the privilege of assisting him in the performance of this operation 
(done at my sitggestion) upon a boy of five years of age afflicted with 
complete epispadia, the abnormal meatus being, as in Page's case, just 
under the pubic arch or slightly above it. Incontinence of urine was 
marked. The operation was done in October of this year. A pair of 
McArthur artery forceps was first introduced through the epispadiac 
meatus and made to bulge out the perineum. The point being cut 
out, a soft rubber catheter was pushed into the bladder and retained 
by a suture. The operation proper was then begun by cutting out 
the urethral trough bodily, by going well beneath it and lifting it 
freely from its place between the cavernous bodies. The dissection 
was carried well back to the infundibulum, the anterior wall of which 
was then caught with forceps and dissected toward the pubic arch 
until the whole urethra, almost into the bladder, was well mobilized 
and could be freely pulled out until it could be extended, as in Beck's 
operation for hypospadia, nearly up to the normal situation of the 
meatus. It then looked very much like an open alligator's mouth. It 
was converted into a complete tube by suturing the sides of this to 
each other. This being done, the corpora cavernosa were separated 
by blunt dissection assisted by occasional snips with the scalpel. The 
glans was partly split, so as to provide a place for lodging the new 
meatus. 

The new-made urethra was then carried through to the under side 



212 MEDICAL SOCIETY OF NEW JERSEY. 

of the penis, and the meatus being sutured in place, the cavernous 
bodies were drawn in front of it and held together by a few sutures 
passed through them. The operation was completed by bringing the 
skin over the corpora in the medis^n line. A very shapely organ was 
the result. The result, after healing, which was somewhat delayed 
and marred by suppuration of the skin flap, while not all that could 
be desired, was most gratifying. The urethra retracted a little back 
from its position in the glans, leaving it practically as a post-balanic 
hypospadia, which. I believe, may be ultimately corrected by Beck's 
procedure of urethral extension. In another case 1 would pierce the 
glans with a trocar or narrow-bladed scalpel and pull the mobilized 
urethra through to its proper position in the glans, and to prevent the 
disturbing effect of sepsis, I would keep the boy in the boric bath, 
as suggested by Page. When the boy was last seen, healing was 
completed, and the incontinence was so much improved that he could 
go regularly two hours or more without wetting his clothes, and we 
feel confident that as he gets older and he brings to his assistance 
the natural feeling of pride, the control will be almost normal. 

Case 5, — Reported by Dr. James Bullitt, at meeting of A. M. A., 
1903. "My own patient operated on in 1 901, was a boy of seven 
years of age, otherwise healthy and well-developed. The meatus was 
beneath the pubic arch, and the foreskin hung down in a well-marked 
apron. On dissecting up the mucous membrane over the sulcus and 
glans penis, it was found impossible to avoid injuring this portion of 
the mucous membrane to such an extent, that it had to be dissected 
and cut away entirely. As a consequence, the new made urethra was 
too short ; even after thoroughly mobilizing it and drawing it Vrell 
forward, it could only be made to reach a point well behind the glans 
penis. It was, therefore, found necessary to adopt the suggestion 
made by Parham, to combine Van Hook's method of tubular canal- 
ization with Cantwell's urethral transplantation. Van Hook, in a case 
of hypospadias, made a canal by tunnelling through the glans penis 
and then lined this canal with a pendunculated flap, coverted by 
sutures into a tube, taken from the preputial hood. The distal end 
of this flap, now became proximal, was finally sutured to the distal 
end of the urethra, so completing the canal. In my case, a sufficient 
flap was cut from the underlying preputial apron, was then converted 
into a tube by suture, and finally was drawn through a tunnel made 
through the glans penis. It was then united over a soft catheter to 



OPERATION FOR COMPLETE EPISPADIA. 213 

the already formed proximal portion of the urethra. The remaining 
steps of the operation were carried out in accordance with CantwelKs 
recommendations. The success of the operation was surprising. 
With the exception of a pin-hole opening, situated a little in front of 
the pubic arch, there was a healing throughout by first intention. 
At the end of ten days the perineal drainage was withdrawn, and 
three weeks after the operation, the boy was exhibited to the Falls 
City Medical Society. He had been instructed to retain his urine 
for several hours before exhibition, a thing utterly impossible before 
operation. Just as he was undressed and placed on the table, he 
found it impossible to longer contain, and 'gave a representation of 
the Brussels' fountain boy, discharging several ounces of urine over 
the table and carpet in a most beautiful stream, from a meatus 
situated at the end of the glans penis. Singularly enough, I found 
the closure of the pin-hole fistula more difficult than the original 
operation. Having failed in one effort to close it, opportunity has 
not yet again presented to successfully deal with it. The boy's conti- 
nence has markedly improved. A recent report informs me that 
there is occasional dribbling by day, and sometimes wetting of the 
bed at night; but this latter is not by dribbling, but by voiding at 
one time a bladderful of wine. 

" In conclusion I desire to say that I feel satisfied that no other 
operation, in my hands, could have produced anything like so good 
a result, in anything like the short space of time." 

Herbert Page, in his article, says : ** That the operation is either 
not known or not appreciated as I think it should be is clear from the 
fact that the most recent book on operative surgery published in this 
country makes no reference to it, and I think the operation is an 
admirable one alike in its conception and in its practical value for 
the cure of a most distressing congenital deformity. I have had one 
case only, but I believe that my friend. Dr. Clutton, has treated two 
or three by it with complete success. It may be said that the result 
of the operation far exceeded our expectations, and while but small 
experience can be gained from one case only, I feel nevertheless that 
the record of it may be of use in calling the attention of surgeons to an 
operation of unquestionable value for the treatment and cure of a mal- 
formation so grievous and distressing as that of complete epispadia. 

Parham, in his article, in speaking of the operations of Thiersch and 
Duplay, says : ** However admirable the result of these procedures 



214 MEDICAL SOCIETY OF NEW JERSEY. 

may be, and they are, as seen in quite a number of successful cases, 
still the length of time required to obtain a final cure has been so 
great as to deter many of us from embarking upon this sea of opera- 
tive difficulties. Thiersch worked one and one*half years to cure one 
of his cases, and remarks that not less than three months should be 
consumed in the treatment of most cases. Pozzi got an excellent 
result by this method in three seances, but such cases as his are rare ; 
most of us would grow weary of waiting for the result, to say nothing 
of the patient. Any method which would give even as good results, 
but in much shorter time, would be welcomed by the surgeon. Such 
an operation, I believe, is that suggested by Cantwell. of Trenton, 
N. J., in 1895. Indeed, our experience in this one case both Dr. 
Martin and myself can say without reservation that this operation of 
Cantwell's is by far the best yet devised for the treatment of epispadia. 
The possibilities of a combination of the suggestions of Cantwell, 
Weller Van Hook, Beck and Nove-Josserand in the management of 
the many variations of this interesting malformation will broaden the 
operative field of both epispadia and hypospadia, and surgeons will 
have cause to be grateful to the genius of American surgeons for giv- 
ing us these notable additions to our resources." 

No operation springs, Minerva like, perfect from the brain of its 
author. I must thank these men for the many valuable suggestions 
which add to the simplicity, convenience and certainly of this 
procedure. 

For the reason that these suggestions are found in their reports 
of cases, I have embodied so much of their articles in this review. 

A proof that this operation is a typical one for this deformity, is the 
fact that when completed, we have a penis normal in the relation of 
its component parts and normal in appearance. In some of the 
cases, the incontinence has disappeared, and to crown the v^hole, 
my first patient became the father of a bouncing girl on May 22, of 
this year. As far as I know, this is the first time that a complete 
epispadias has become the father of a child. 



INFANTILE COLIC. 

BY ALEXANDER McALISTER, CAMDEN, N. J. 

Many little things are in reality the great things of life. The 

observation is that of a philosopher, simply borrowed for the 

occasion. The statement has a threefold application to infantile 



INFANTILE COLIC. 21 5 

colic. It applies to the infant itself, especially in its earliest life ; to 
the mother, particularly if she be young and inexperienced, and to 
the family physician. By the law of continuity, it applies as well to 
the infant's father, but this observation of the philosopher we will 
not stop to borrow. 

It need not be remarked that colic is one of the first thorns in the 
infant's pathway, and of frequent occurrence, especially in infants 
deprived of breast milk ; that colic is merely a symptom ; and that 
its presence and prevalance are only exceptionally indicative of 
disease. Disease is rather a result of an attack of colic upon the 
comforts of the infants and the household in general. Colic is a 
discordant note in the tenor of the young life, an indication of the 
presence of a disturbing factor by no means always arising from 
improper food or faulty digestion. 

It is not the present purpose to write exhaustively, but simply to 
call attention to a few pertinent points in the causation, diagnosis 
and treatment of infantile colic. 

The most commonplace and trivial circumstance, in the life of the 
mother may excite an attack of colic in the tender nurseling. An 
irregularity in her diet, her physicial activity or her mental equi- 
librium may be the sole and unexpected exciting cause of an attack or 
repeated attacks of colic. Thus a toothsome condiment sparingly 
indulged, moderate exercise and a mild burst of passion in the mother 
may yield the same disturbance in the physicial atmosphere of the 
infant. 

On the other hand, lack of cleanliness in the nursing bottle or 
nipple, too rapid feeding, too frequent or too long deferred feeding 
in the artificially fed, may be enumerated as common causes of 
attacks of colic. On this score alone, the hose and nipple equip- 
ment of nursing bottles cannot be too strongly condemned. The 
long tube and small nipple present a number of nursery conveniences 
which should never offset their one great disadvantage. With the 
greatest possible care they cannot be kept sufficiently clean and 
hygienic. On the other hand, they are always of too great immediate 
service for the infant's best welfare. The writer recommends only 
the bottle nipple. Nature has wisely designed that even the tenderest 
infant shall pay the price of labor for its sustenance. This it is 
always compelled to do when drawing milk from the mother's 
breast. At birth its cheek muscles are already well developed for 



2l6 MEDICAL SOCIETY OF NEW JERSEY. 

this sole purpose. In the normal amount of labor expended to 
secure the breast milk, the salivary glands are vigorously stimu- 
lated and the milk reaches the stomach well mixed with saliva. 

These ideal conditions are seldom duplicated in artificially fed 
infants. Rubber nipples are more easily plied than fleshly nipples. 
They are of necessity patulous and yield milk rapidly and with 
comparatively little labor on the part of the infant. After several 
nursings, rubber becomes soft and admits of a veritable stream with- 
out much effort. For these reasons infants prefer rubber nipples, 
and it is a stubborn fact that when they have had rubber nipples for 
a short time they will not again return to breast nursing. 

This subject is treated so fully in order to emphasize the impor- 
tance of proper care in the selection, use and rejection of nipples. 
Probably half the nipples in the shops should never be used, or 
be used only a few days. The best should not be used more than 
ten days or two weeks. It is the writer's uniform practice to restrict 
the use of any nipple to two weeks, and to order the employment of 
two nipples, that one may lie in an alkaline cleansing wash while the 
other is doing service. 

As a rule an attendant should always hold the bottle while the 
infant is taking nourishment. Only in this way can the evils of too 
rapid feeding be avoided. 

Mothers frequently charge their infants with excessive greed and 
rightfully attribute to this, attacks of colic. In many such instances, 
the fault is not in the infant, but in the nipple. What is interpreted 
as greed, is simply effort to avoid choking. The volume of milk 
passing through the nipple necessitates rapid swallowing, and what 
seems to be voracity, is in reality distress. 

The diagnosis of colic is not always correctly made without a care- 
ful physicial examination. Mothers may judge wrongly. The cry 
which the mother quickly accepts as an infallible sign of colic is only 
an expression of distress, which may, or may not be due to pain, 
especially in older infants. 

Pain in the very young may result from soreness incidental to 
birth, griping accompanying the earliest movements of the bowels, 
urinary retention caused by phimosis, renal colic and kindred incidents 
in the establishment of normal functions. In older infants, earache, 
teething, soreness in the abdominal muscles, tender joints due to 
rickets and other painful maladies, must be considered in the 
diagnosis of colic. 



INFANTILE COLIC. 21/ 

The signs of colic are well known, but require for their recognition 
more or less physicial examination. These signs are hardness of the 
abdomen, palpation of coils of intestines, tendency of the infant to draw 
up the legs and the expulsion of flatus, accompanied by vigorous 
crying. Cessation of crying after the passage of flatus is, of course, 
always a sign of the proper diagnosis. 

Enors in diagnosis not infrequently lead to misapprehension and 
early weaning with disastrous results. The infant has discomfort 
which is at once wrongly attributed to colic. The usual household 
remedies bring no relief. Hunger supervenes upon copious draughts 
of hot water and crying continues. At this junction, charges are 
made against the breast milk. The infant is offered a nursing bottle 
and its entire future at once assumes a different character. In this 
disastrous transaction, the family physician, willingly or unwillingly, 
is not infrequently a party. 

In the treatment of infantile colic too careful circumspection in the 
use of drugs cannot be practiced. The prompt relief which narcotics 
affords has power to hypnotize the dearest guardian and entail serious 
results upon a helpless life. A drop of paregoric is but the forerunner 
of ten drops, or of that still more charming dose, a drop of laudanum, 
and this point reached, the seeds of a drug habit, or, later in life, an 
alcohol habit, are securely planted. The fact that the family physician 
ordered an opiate on a certain occasion is too frequently taken by 
parents as authority to use opiates on every occasion. The tendency 
to use the soothing syrups of the shops needs no encouragement. 
All these and kindred facts merit due consideration in the treatment 
of colic. 

Many cases can be promptly relieved by a little manipulation of the 
infant, with or without gentle massage of the abdomen. This method 
of treatment would be too trivial for recognition in this connection 
were we not considering little things of life. On the other hand, it 
may be observed that the family physician may not infrequently ren- 
der the highest service by instructing the mother or nurse how to 
jump an infant, abdomen down, in order to secure relief from colic. 
Many cases of so-called colic are simply flatulency, or in nursery par- 
lance, " wind on the stomach." In all such cases manipulation is the 
only legitimate treatment. 

Next to the foregoing, the remedy of greatest value in the 
treatment of infantile colic is warmth. This may be applied to the 



2l8 MEDICAL SOCIETY OF NEW JERSEY. 

abdomen dry or moist, or employed internally in the form of sips of 
hot water, or of hot enemas. Friction with warm oil along the line of 
the colon is of special value because combining warmth with manip- 
ulation. 

The most unique means for applying warmth in the treatment of 
infantile colic is a small hot water bag. The writer has found these 
bags generally serviceable, and never fails to order one when such 
treatment is required. They may be utilized in very ybung infants 
with entire satisfaction. Infants will fall into quiet sleep with a bag 
resting upon the abdomen. The treatment cannot harm, no matter 
how frequently or persistently employed. On the other hand, such 
treatment is decidedly beneficial also in improving digestion and 
nutrition. 

In spite of every effort to the contrary, some cases, especially in 
older infants, require medication with carminatives. In such the 
standard teas frequently prove too weak. Resort must be had to 
more concentrated remedies. 

The formula of paregoric with opium excluded makes a remedy of 
considerable value. The dose is easily regulated, beginning with a 
few drops, to the requirements of the case. 

Rotch recommends that carminatives be administered with alkalies 
between feedings to counteract the high degree of acidity of the stom- 
ach always present, especi.ally in bottle-fed infants. The following is 
one of his favorite prescriptions : 

5^ Sodii bicarb 40 grs. 

Spts. Ammon. Arom 40 m. 

Glycerini 30 m. 

Aqua Menth pip. q. s ad 2 oz. 

Sig : One teaspoonful between feedings. 
When acidity is not an element requiring special treatment lac 
asafetida is frequently of value. 

In concluding, it may be remarked that the use of narcotics in the 
treatment of infantile colic is only exceptionally justifiable. 
DISCUSSION. 

Dr. William E. Darnall, of Atlantic City.— I think every 
physician understands what infantile colic is, but one often meets 
with difiiculty in relieving it. It is usually merely functional, but it 
may be a symptom of a very grave disorder; hence the necessity 



INFANTILE COLIC. 219 

for careful differential diagnosis. The wise old ladies tell us, 
and it seems to be borne out by experience, that boys are more 
subject to colic than girls. The cause I do not know. As a 
rule there is an accumulation of gas in the bowel and stomach, 
which produces increased or spasmodic peristalsis. The cause may 
lie in the infant or in the mother. It should be borne in mind that a 
child which has been nourished tn \utero for nine months often has 
weak and undeveloped digestive organs, and as a result, these organs 
cannot always stand the sudden strain thrown upon them when it is 
born into entirely new and different environments. A point of 
importance, which I think has not been mentioned, is the influence of 
the pancreas. We know that the pancreatic juice is of great import- 
ance in digesting the albuminoids, and we also know that the pancreas 
is not matured until the end of the first year. It is easy to understand, 
therefore, why digestion of these substances is often deficient, and as 
a result, colic ensues. The reader of the paper has well brought out 
the causes which lie in the mother. Among these causes are various 
laxatives and purgative drugs taken by the mother. Perhaps it does 
not produce the same colic, but does produce increased and painful 
peristalsis. The effect of worry, anger and the general mental state 
of the nursing mother have been referred to. That wonderful 
observer, Dewees, noticed that an attack of pain may produce an 
attack of colic in the infant. He noticed that a child suffered per- 
sistently for a long time with colic, and that during this time the 
mother was suffering severely from toothache. On removing the 
offending tooth her pain and the infant's colic both ceased. The 
most common form of colic is that due to the food. The composition 
of the food may be correct, and yet the infant may be given too great 
a quantity of the food. As a rule, however, the percentage of the 
proteids is too large, although sometimes the colic is due to too much 
sugar. With underfed nurslings we meet with increased peristalsis 
very often. The child constantly tugs at the breast, and the increased 
peristalsis becomes painful. The influence of cold in connection with 
such infantile disorders is potent. If a child is allowed to lie too long 
in a wet diaper, its body may become chilled and colic result. Dr. 
Illoway. of New York, lays great stress upon the play of the features 
in diagnosticating infantile colic of functional nature. In the 
more serious disorders in which colic is a symptom, the child does 
not draw up its limbs against the abdomen as he does in the ordinary 



220 MEDICAL SOCIETY OF NEW JERSEY. 

simple functional form. The author's statement regarding the value 
of heat in the treatment of colic is worthy of emphasis. These chil- 
dren should not be given opiates or narcotics of any kind except in 
those rare cases when nothing else succeeds. 

Dr. John C. Johnson, of Blairstown.— I would refer to the exist- 
ence of a small umbilical hernia as a cause of infantile colic, a cause 
which is not uncommon, and yet has not been mentioned so far in 
this discussion. 



The Alexander Operation in the Treatment 
OF Retro-Displacement of the Uterus. 

BY F. M. DONAHUE, NEW BRUNSWICK. 

In speaking of the Alexander operation in the treatment of retro- 
displacements of the uterus, I do not wish to say that it will prove 
a cure-all for every backward displacement, for there are many 
conditions in which displacement backward occurs, and for which 
the operation should not be undertaken with any hope of giving re- 
lief. In fibroid tumors of the posterior wall of the uterus, that 
portion often becomes bent, and retro-flexation of the uterus takes 
place ; there it would be manifestly unfair to expect an Alexander 
operation to do any good at all, and so, in the same sense, are 
fibroids of the anterior wall of the uterus which, by their growth and 
the pressure they exert, produce a retro-version of the uterus. 
These fibroids and the displacements which they produce, should 
have some other form of treatment than the operation of which I 
speak. 

In retro-displacements with adhesion of the fundus uteri to the 
rectum or to the peritoneum in Douglas's pouch ; these conditions 
are usually the result of a pelvic peritonitis, set up by a septic endo- 
metritis which extends through the tubes to the pelvic peritoneum 
or through the lymphatics of the uterus to the broad ligaments and 
so to the pelvic peritoneum and the uterus is bound down. It can- 
not be lifted up in the position of anteversion, or if lifted in this 
position, remains so only a few minutes, to sink back again as soon 
as the force applied is removed. This condition requires a different 
procedure, which will be mentioned later on. 

In disease of the tubes and ovaries when the tubes contain pus. 



THE ALEXANDER OPERATION. 221 

blood, or serum, or when the ovaries are cystic and enlarged ; with 
these conditions there is frequently a backward displacement of the 
uterus. Here the Alexander operation is particularly contra-vindi- 
cated, for you cannot treat the disease of the adnexa by an Alexander 
operation, and it is this disease which requires treatment, and not 
the displacement. The one essential for a good result after an 
Alexander operation, is that the uterus shall be freely movable and 
that the tubes and ovaries shall be healthy. 

In many cases there will be associated with the displacement an 
endometritis due to the long continued displacement, producing a 
congestion of the uterus so leading to this condition. Here a dila- 
tation of the uterus and a currettage should be done first and the 
Alexander operation immediately afterwards. 

In my student days under the late Prof. Munde, the treatment of 
retro-version of the uterus was entirely by pessaries. If the ujerus 
could be replaced and stayed in place, a pessary was introduced and 
the woman was allowed to go, to return once a month, or once in 
two months, to have the pessary removed, cleansed and replaced. So 
these poor sufferers were a constant source of annoyance and some- 
times of an income to the practitioner. If the uterus was adherent, 
the Thure Brandt method was tried, followed by applications of 
iodine to the vault of the vagina and the introduction of boro- 
glyceride tampons, to be renewed once or twice a week according 
to the indications. These patients were seldom cured ; they would 
go from one physician to^anolher to have only the same treatment 
applied. 

Dr. Alexander devised the operation which bears his name and 
which forms the title of this paper. It consists of shortening the 
round ligaments by an incision through the anterior abdominal wall 
down to the external ring. The aponeurosis is divided, the ligament 
seized as it emerges from the external ring, pulled out till the fundus 
is against the symphysis pubes and then stitched to the pillars of the 
external abdominal ring. 

Wylie opened the abdominal cavity and shortened the ligaments 
within the abdomen. Kelley opened the abdomen and stitched the 
fundus uteri to the peritoneum of the anterior abdominal wall. 
Mackenrodt does a shortening of the round ligaments through the 
vagina, while Gillian opens the abdomen, perforates the sheath of 
the rectus abdominis muscle and stitches the round ligament in this 



222 MEDICAL SOCIETY OF NEW JERSEY. 

position. While all these operations have their advantages, the one 
great disadvantage which they have as compared to the Alexander 
operation, is that you must open the peritoneal cavity for their per- 
formance, and no matter how careful we may be of our asepsis, 
occasionally we get a septic infection with all of its dire consequences. 
The operation of Wylie is good if you have conditions which require 
you to open the peritoneal cavil y. After dealing with adhesions, or 
tubal, or ovarian disease, the round ligaments are seized on either 
side with an artery forceps and pulled up, they form a triangle ; the 
apex, in the grasp of the forceps, the base at the broad ligaments ; 
with a straight needle and catgut the two legs are sewed together and 
the round ligaments are shortened in proportion to the extent of the 
pull. 

Kelly opens the abdomen, lifts up the uterus, puts in two stitches 
in the peritoneum of the anterior abdominal wall and through the 
fundus, behind the attachments of the broad ligaments. 

Mackenrodt makes two small incisions on each side of the cervix 
uteri in the vagina, grasps the round ligaments, pulls them down 
into the vagina and stitches them with catgut. While Gilliam opens 
the abdomen, frees the uterus, perforates the sheath of the rectus 
muscle, draws the round ligaments through the perforations and 
stitches them there. 

The one objection to the Kelley operation, or to any operation 
which fixes the uterus to the anterior abdominal wall is, in the words 
of Prof. Polk, " You make one lesion to cure another." 

The fixation of the uterus to the abdominal wall begets congestion 
and congestion begets endo-metritis. 

Another point : If the woman be of child-bearing age and married, 
pregnancy may occur. If she does not miscarry* there may be con- 
siderable difficulty in delivering the child, Csesarian section having 
been resorted to in a number of instances to effect delivery. In cases 
where the uterus is adherent, and where there is no disease of the 
tubes and ovaries, I have adopted the method of Professor Polk, in 
making a vaginal incision in Douglas's pouch, breaking up the adhe- 
sions with one finger, putting a stitch or two in the vaginal incision, 
and then completing the procedure by an Alexander operation. 

To do an Alexander operation properly the following procedure is 
adopted: The uterus is first determined to.be movable, and that 
there is no disease of the tubes or ovaries. The vagina is scrubbed 



RETRO-DISPLACEMENTS OF THE UTERUS. 223 

with hot water and soap» then washed with bichloride solution and, 
finally, alcohol. The abdomen is scrubbed and shaved, as in the 
preparation for a laparotomy. If there is an endo-metritis the uterus 
is first dilated and curetted. This is done with bare hands. Rubber 
gloves are now put on and the Alexander operation is done by making 
an incision parallel with Poupart's ligament and about one inch above 
it. The tissues are divided down to the fascia of the abdominal 
muscles. This exposes the external abdominal ring. 

The aponeurosis covering the external ring is next picked up 
between artery forceps and divided, when the ligaments may be seen. 
It is pulled out, stripping the peritoneum from off it as it emerges. 
It is now stitched with silk-worm gut sutures, using a figure of eight 
suture, and stitched to the pillars of the ring, and then an antiseptic 
dressing is applied. The first dressing is done about the fifth day, 
when, if everything is doing well, a second dressing may be applied, 
which is allowed to remain until the twelfth day, when the stitches 
are removed. 

The woman is allowed to sit up on the fourteenth day and to go 
about gradually from then on. A pessary is always inserted to be 
worn for two or three months, until the ligaments are firmly bound 
in their new position. In forty cases in which the writer has done 
this operation, all but ten have been heard from. They are all well 
anatomically and symptomatically. Of these forty cases twenty-five 
were in married woman. Six of these, or about 25 per cent., have 
been pregnant after from two to seven years of sterility, and have been 
delivered of full-term children without recurrence of the displace- 
ment. Two were widows, and thirteen were in the unmarried class. 

These, gentlemen, are my views in regard to a procedure which, in 
carefully selected cases, is capable of effecting a cure in a very trouble- 
some class of cases and without any mortality. 



Retro-Displacements of the Uterus and their 
Treatment. 

BY J. M. BALDY, M. D., OF PHILADELPHIA, PA. 

There was a time when ascites was described as a disease and was 
generally accepted as such. Now we all know it to be but the indt- 
cation of some^disease (such as liver, heart, kidney or peritoneum, 
etc.), and it would be a bold man who would venture to describe 
ascites as a distinct disease. 



224 MEDICAL SOCIETY OF NEW JERSEY. 

So it is with retro-displacements of the uterus. Gynecology roved 
in the uncertainties of developntent for many long years, and although 
we are now almost at the finish, we still have a few legacies of the 
" dark ages." Retro-displacements are notably one of these legacies. 
But the time will come when men will be just as much ashamed to 
speak and write of them as a distinct disease as they are at present of 
ascites. 

All rules have exceptions which in no way vitiate the truth of the 
rule ; and so it is with retro-displacements. There are a few cases 
where it seems as though the displacement was the only thing which 
would explain the symptoms and a replacement of the womb cures 
the case. These cases are the great exception, however, and in no 
way shakes our faith in the rule. In fact, many of these apparent 
exceptions have other possible, if far-fetched, explanations. 

The rule is this, viz: Retro-displacements of the uterus are mostly 
coincident with other lesions, and where such is the case, the symp- 
toms almost universally come from the associated disease. 

Any number of cases of displacement are reported, and volumes 
are written on the subject — men continually tell me of innumerable 
cases they have in their practice, etc., etc., but, to be perfectly frank, 
the fault is not with the condition, but mostly with the lack of accuracy 
in the diagnosis of the practitioner. I say this in a spirit of charity, 
not of wanton criticism ; it is true in either case. When a practitioner 
of medicine has a case of retro-displacement of the uterus, together 
with a prolapse of the ovaries, which ovaries are possibly adherent, or, 
at least, schirrotic. and he only sees the displacement of the womb 
and believes that this creates the symptoms, why should he complain 
if I suggest that his diagnostic powers are a bit undeveloped ; and 
this in spite of the fact that a replacement of the pelvic organs by a 
pessary or an operation may have relieved the symptoms. He has 
simply stumbled on a cure in that individual case without a true 
appreciation of the pathological condition present ; but where he has 
stumbled upon a cure in this one case, he will probably fail to even 
obtain relief in the next half-dozen or so. 

The most common disease with which displacements of the uterus 
are associated (and which, in fact, often causes the displacement) is 
inflammatory disease of the pelvis. Child-bearing, neoplasms and 
traumatisms cause the bulk of the remainder. 

A retro-displacement of the uterus, even with prolapse of the 



RETRO-DISPLACEMENTS OF THE UTERUS. 225 

ovaries, may exist for years without producing a symptom disagree- 
able to the woman. Eventually, it is true, many of them give rise to 
troubles. Given a young woman with such a condition, free from 
symptoms for years (and this often occurs), matrimony intervenes, 
and within from three months to a year sexual life causes sufficient 
irritation to those ovaries to send the woman to a doctor — mark you, 
I say ovaries^ not uterus. If the ovaries were out of the way and 
uninvolved the uterus itself would give little or no trouble. Even 
when the fundus becomes tender, as is so often the case, it is almost 
always due to the reflex irritation from the tender ovaries or to the 
direct adhesions of the fundus itself. A displaced uterus, which even 
in a married woman is giving no trouble, will, if a puerperal septic 
attack or a gonorrhoea! infection supervenes, becomes at once trouble- 
some. More so is this true than it is of a set of organs in an upright 
position. But who will venture to contend that in any of these cases 
it is the displaced uterus which is the disease and not the new factor 
which has entered into the case. 

The more I see of gynecological practice, the fewer unexplained 
cases of apparent trouble from retro-displacements come under obser- 
vation and the more am I inclined to limit the list of exceptions. In 
too many cases where I had at my examination (even with the patient 
under the influence of an anaesthetic) thought that I had a simple case 
of displacement with no complication, have I found myself mistaken 
at a subsequent operation in which the abdomen was opened and the 
parts directly inspected, to place very much reliance on men's diagnosis 
as regards adhesions and minute lesions of the appendages when they 
have had no subsequent opportunity of seeing in that pelvis. *' The 
treatment of retro-displacements "is, then, a misnomer ; it should be, 
** the treatment of conditions in which retro-displacements occur as 
an incident." In most of these cases the displacement of the womb 
itself can be ignored and the result be perfectly satisfactory, as years 
of abdominal surgery have taught. A discussion of these conditions 
would mean a discussion of the treatment of almost all the pelvic 
ailments of women. Suffice it to say, that each disease found, be it 
the result of puerperal septicaemia, gonorrhoea! infection, schirrotic 
disease of the appendages, neoplasms, adhesions, or anything else, is 
to be treated on the proper line of treatment for that disease, which- 
ever may obtain. 

In those few cases in which no disease can be found, and again, in 

15 



226 MEDICAL SOCIETY OF NEW JERSEY. 

those cases where the disease found has been dealt with by the appro- 
priate treatment, and it is in addition decided desirable to bring a 
retro-displaced fundus forward (for instance, where the peritoneum of 
the pelvic walls back of the womb and broad ligaments are denuded 
and bleeding, and where adhesions between them and the fundus 
would occur if they were allowed to come again in contact, or where 
it is desirable to draw up prolapsed ovaries, etc., etc.), there is a 
choice of methods, to which I may be permitted to call your attention. 
Some of us have seen the day when the clamp was used in the 
treatment of the stump in the removal of ovarian tumors ; the liga- 
ture took its place and the clamp passed into history as a necessary 
and interesting step in the development of the completed and simple 
operation of to-day. The same thing took place in the evolution of 
hysterectomy for fibroid tumors of the womb and other conditions. 
The same transition is now taking place in the surgical treatment of 
cases complicated with retro-displacements of the uterus. A short 
while yet and Alexander's operation, hysterorrhaphy. ventro-suspension 
and similar operations will have become history. The results of some 
of these primarily are uncertain, and the operations must be done in 
the uncertainty of diagnosis, notably in Alexander's operation. In 
the balance of these subsequent complications and distochias in sub- 
sequent pregnancies have been so many and serious, that men have in 
ever-increasing numbers been driven to search for something which 
would prove a safe and final substitute. This has, I believe, been 
found in operations on the round ligament, intra-abdominal. Theo- 
retically, these operations fulfill all the indications desired. They 
open the way to a thorough inspection of the parts and to an intelli- 
gent application of the proper treatment to any complication existing. 
They do not weaken any of the already weak canals of the body (the 
inguinal canals). There is no chance of failure of the operation, 
such as tearing the ligaments or failing to bring them out, as happens 
in the best of hands with Alexander's operation. They cause no 
unnatural attachment and no adhesions which can possibly give sub- 
sequent trouble. They leave the uterus a pelvic organ, and do not 
draw it up into the abdomen. They bring the womb into a perfect 
anterior position, holds it there accurately and with certainty, and at 
the same time leaves it freely movable. The only objection I 
can see which can be advanced against them is the danger of opening 
the abdomen. With any one who sees this as a serious danger Or 



RETRO-DISPLACEMENTS OF THE UTERUS. 22/ 

objection, under the circumstances. I do not care to discuss the sub- 
ject ; I simply have no faith in his surgical judgment and skill. 

The number of this class of operations, all based on the same 
principle, but differing in details, is large. Many of them are good, 
but some are more simple than others. The one I practice myself 
is as follows: 

When the abdomen is opened, adhesions freed, if any, and the 
uterus brought forward ; a pair of forceps is forced through the 
broad ligaments on each side of the uterus at a point near the uterus. 
The forceps penetrate from the posterior surface of the broad 
ligament and come out on the anterior or bladder surface, just under 
the round ligament, half an inch from its uterine attachment. The 
round ligaments are now pushed into the bit of the forceps and 
the forceps are drawn back, bringing the round ligament with them 
through the holes. The ligaments are then brought together form- 
ing a loop behind the uterus. A silk stitch now binds the round 
ligaments together and the forceps are removed. The uterus is now 
held well forward by the finger of the assistant, while the operator 
forces the round-ligament (with a pair of tissue forceps), as low on 
the posterior part of the uterus as he desires, and stitches them to 
the peritoneum of the uterus, at this point, with fine silk. This is 
about at the internal os, or lower. The result is a sling back of 
and around the uterus which holds it in perfect position, leaves it 
movable and does not lift it out of the pelvis. In addition,] this 
procedure does what none of the other operations of any kind does ; 
it twists the tops of the broad ligament forward in such a way as 
to lift the prolapsed ovaries up even as high as the ileo-pectoneal 
line, giving them perfect suspension, without in any way interfer- 
ing with the calibre of the fallopian tubes. 

If the round-ligaments are too short to be brought back in this 
way (they come back doubled on themselves), I cut them off near 
their uterine attachment, and after tying the blood vessels, bring the 
free ends back and attach them as a loop, or if still too short for 
this. I stitch the end of each round ligament onto the posterior 
surface of the uterus at such a point as to give the support desired. 

The question of the use of pessaries I shall not discuss; their 
utility is so limited that even where they do apparent good, it is so 
questionable, that it is almost time wasted. This I will say, that 
in the vast majority of cases in which they will relieve unpleasant 



228 MEDICAL SOCIETY OF NEW JERSEY. 

symptoms, a tampon will do quite as well, and is much safer. 
The two classes of cases in which relief is experienced by their use 
are chronic pelvic inflammatory troubles (where they are a positive 
element of danger), and in cases of retro-displacement with pro- 
lapse and disease of the ovaries. A few of these cases are relieved 
through the use of a pessary, by lifting up the vaginal vault and 
relieving the general weight and drag. The great majority of even 
this class of cases will not tolerate the presence of the instrument, 
so painful is it. In my experience the vast majority of women who 
come to me for consultation, in whose vagina I find a pessary, have 
perfectly normal pelvic organs, in such condition and position as to 
make it perfectly plain that they had never been displaced. These 
women are usually suffering from gastro-intestinal disturbances or 
from neurasthenia, or from both. This state of affairs is the result of 
the teaching of the past ; is it not time that those of you who know 
better take an emphatic and unequivocal stand in the matter? 
Balance all possible good from the use of pessaries with the harm, 
and there can be no question but that it would be better for women 
if the profession could forget there was such a thing as a pessar}'. 

DISCUSSION. 

Dr. Mortimer Lampson, of Jersey City. — I am in a somewhat 
embarrassing position, being called upon to discuss a paper which is 
essentially g}'necological, while I am a general surgeon. I am not 
in exactly the same position as the late Dr. Abernethy who, when he 
sprained his ankle, called in a certain professor of obstetrics. A 
friend remonstrated with him for having called an obstetrician, to 
which Abernethy replied that he thought it was proper enough, for 
he had certainly had a miscarriage. The author of the last papef 
expressed exactly my ideas of the Alexander operation. As I under- 
stand the subject, the Alexander operation is based on wrong 
anatomical conditions and is essentially wrong in its conception. In 
looking at the round-ligaments, a yachtsman would notice the re- 
semblance to the backstay of a yacht. If the round ligament were a 
backstay, or a frontstay, it would have been constructed more like 
the utero-sacral ligaments. Anatomically, it contains erectile tissues 
and other tissues which are very far from being designed to give 
firm support. Why Alexander should have selected this ligament 
for pulling the uterus forward, I cannot understand. My experience 
with the Alexander operation has been limited to a very few 



RETRO-DISPLACEMENTS OF THE UTERUS. 229 

cases, although I have seen the operation frequently performed, 
and I have noted that many such operators failed very much 
like a mountaineer called in a celebrated trial in Virginia. He 
was called to testify in the case, and the prosecuting attorney 
asked him his name. He answered "Jim Jones," and that he 
lived "over in the mountain." " Now sir," said the attorney, 
"were you present at Harper's Ferry on the nineteenth of February? '' 
Jones by that time had become very much frightened, and he said : 
" I don't know Harper or where he keeps his cursed ferry." I may 
add that the surgeons whom I have seen essay the Alexander oper- 
ation, have failed very much like this man Jones. I recall one case 
in which the surgeon fished for one hour for the round ligament, 
and finally gave up the search, concluding the operation by opening 
the abdomen and making an anterior suspension. The operation of 
Kelly is the better, if one feels that any modification of the Alexander 
operation is desirable. I have done ventral suspension several times 
after having failed with the Alexander operation. 

Dr. Emery Marvel, of Atlantic City.— I am very glad that the 
authors of these two papers have taken the position that the treat- 
ment of retro-displacements is operative, and that they do not advise 
the use of such supports as pessaries. I am especially pleased with 
the position taken by Dr. Baldy. The operations which utilize the 
normal structures for the support of the uterus are those which 
make use of the round ligament, such as Alexander's operation, 
Mann's operation, Wylie's operation and Dudley's operation. There 
are two or three objections, it seems to me, to the Alexander oper- 
ation. The one advanced by Dr. Baldy is that the operator works 
in the dark and certain complications may be overlooked, and hence 
not corrected. It is very true, as has been said, that there are often 
tubal or ovarian complications, or adhesions, and these must be 
relieved before a complete cure can be affected. The objection 
made to the other operations, that the peritoneal cavity is opened, 
does not seem to me to have much weight. Another objection is the 
risk of hernia, but with the Alexander operation there are two 
possibilities of causing hernia, whereas by median incision there is 
only one such possibility. Bov6 has utilized the utero-sacral liga- 
ment in pulling the cervix uteri back. Of those operations which 
utilize the abnormal structures, ventral suspension is perhaps the 
one mjost performed, and it certainly has done much good. Dystocia 



230 MEDICAL SOCIETY OF NEW JERSEY. 

is probably the greatest objection. I have recently attended such a 
woman in confinement, and her labor was much easier than those 
occurring before the operation. The operation of excising the round 
ligaments, making a window through the broad ligament, and passing 
' the round ligaments posterior to the uterus and making a sling, seems 
to be a promising procedure. I had the pleasure of seeing this 
operation done by Dr. Baldy, and while I was favorably impressed 
with it, it has occurred to me that there is an objection to it. We 
should retain all of the support that the uterus had originally, if we 
cut the round ligament, we certainly weaken that support, and if we 
pass it posteriorly, we must depend upon the strong adhesions which 
we secure on the posterior surface of the uterus. It is possible that 
these adhesions will not be secured, and in such an event, the oper- 
ation not only fails, but the original support is weakened. Recently, 
Dr. Byford has described, what seems to me, a perfect operation for 
retaining the uterus in a normal position. He utilizes the round 
ligaments. A fold is made in the round ligament and the end of 
fold is brought to the upper surface of the internal inguinal ring 
and fastened there. In so doing, not only shortening the round 
ligament, but duplicating its supporting function. 

Dr. Philander A. Harris, of Paterson.— I am very glad that 
Dr. Baldy has came to us and presented a paper which has covered 
the more important points on retro-deviation of the uterus. By the 
reading of his valuable paper, he has conferred a benefit upon all 
those who believe what he has said. Those who do not, will have a 
certain time in which to get right on this subject. Dr. Baldy has 
told us in polite terms that simple retro-version of the uterus is a 
comparatively symptoniless disease. He has pointed out the various 
diseases in the pelvjs, which have caused the symptoms so generally 
attributed to retro-deviations of the uterus. I think that any doubting 
ones cannot do better than read this paper over and over again, until 
they have correct and settled ideas on the subject. I believe he has 
spoken the full truth to us, and has rendered the profession a great 
service by again pointing out the many associated diseased con- 
ditions which are responsible for the symptoms, which in times past, 
we were accustomed to attribute to simple retro-displacements. 

I cannot ask you to adopt Dr. Baldy 's operation, because I have 
had no experience with it. I was especially discouraged from con- 
tinuing to endorse the Alexander operation, because of the remarks 



RETRO-DISPLACEMENTS OF THE UTERUS. 231 

made in the New York Academy of Medicine by the younger men 
of New York, who have found in their dispensaries, many cases of 
hernia following that operation. Such a class of observers know 
almost more about the failures of gynecology, than do the operators 
themselves. 

The previous speaker has very justly said, that the central incision 
presents rather 1q3s liability to hernia, than inguinal incisions and 
that it possesses the additional advantage of reducing by one-half, 
the total number of abdominal sections for retro-displacements. 

With regard to pessaries, I would say that they occasionally do 
good for retro-displacements of the uterus, where there is no other 
pathology. 

Dr. C. p. Noble, of Philadelphia.— Very much has been said by 
Dr. Baldy that cannot help but receive the support of those who have 
had much to do with these cases. He put many valuable truths in very 
strong terms. 1 believe there are many cases of uncomplicated retro- 
versions that do produce symptoms, and I believe many of . those 
cases soon become complicated by prolapse of the ovaries ; whereas, 
if the case had been cured before this time, prolapse of the ovaries 
would not have occurred. I sharply separate the uncomplicated from 
the complicated cases of retroversion. I cure the uncomplicated 
cases by the Alexander operation. In the complicated cases the 
chief complications are inflammatory diseases of the appendages and 
prolapse and congestion of the ovaries. I have found no difficulty in 
curing the uncomplicated cases by means of the Alexander operation. 
One speaker has said that the Alexander operation is unphilosophical, 
but it should be remembered that the round ligament acts by tilting 
the uterus forward, and then it is kept in position by the intra- 
abdominal pressure, thus converting this ordinarily destructive factor 
into a conservative factor. I have done the Alexander operation over 
two hundred times. As my experience has increased I have been 
more and more impressed with the value of the operation. I have 
never known a hernia to follow an Alexander operation, so that I do not 
think many such herniae occur if the operation is done properly ; /. ^., 
if it is finished with a Bassini operation. In complicated cases, those 
in which there is disease of the appendages, the Alexander operation 
is, of course, contra-indicated. It has not been my experience that in 
cases in which the Alexander operation has been done there has been 
any difticulty arising from overlooking disease of the appendages. 



232 MEDICAL SOCIETY OF NEW JERSEY. 

Where the retroversion is merely an incident to disease of the appen- 
dages, of course one should operate upon the appendages. Where 
this becomes necessary, I think it is far better to remove the uterus 
also. 

Dr. E. J. Ill, of Newark, — I am very glad to hear Dr. Noble 
speak as he does, for I am very sure that extreme opinions are apt to 
be erroneons. The first speaker told us that the Alexander operation 
was a foolish operation, and he admits he has 4one the operation only 
two or three times, and saw it done by an inexperienced operator 
another time. He really knows nothing about it. If you desire to 
know about the operation, ask Dr. Noble, or see such men as Drs. 
Polk and Ediboles, of New York, or, pehaps. Dr. Goldspohn, of 
Chicago. The latter gentleman is, perhaps, the best authority in the 
country. He not only does the operation, but resects tubes and 
separates adhesions of the uterus, and has repeatedly published his 
results — results that are not impressions, but carefully recorded cases — 
cases that have been followed up for months and years. It is such 
work as his that needs our careful perusal. 

The pathology of the retroflexed uterus is an important matter. We 
are told that the disease of the appendages is primary and the uterine 
disease secondary. This holds good only in a limited number of 
cases. In a majority of cases I prefer to say that the uterus has fallen 
down, and, as a result, there has developed an induration of the stroma 
of the ovary. 

The reader of the paper tells us of a newly devised operation, 
which has the fault of many others, /'. ^., that the uterus is suspended 
by the weakest portion of the round ligament, /*. ^., the distal end. 

We have been told that pessaries are things of the past, but this is 
not so, and I should say that nine-tenths of the men present here who 
work at all in this line, and are not operators, obtain a great deal of 
benefit for their patients from such treatment. It is not at all nec- 
essary to operate in every case, and I do not believe any one who 
knows me will say that I am afraid to operate. We have heard a 
good deal of talk, but we have not been presented with figures ; it 
has been simply a matter of '* impression." 

Dr. Baldy. — It has been said that figures talk, but I would say that 
nothing lies so much as figures. I am astonished at Dr. Ill's criti- 
cism. He is inconsistent, as he himself criticises my operation, and yet 
he has not done it at all. Consistency is a jewel ! I do not know of 



MOSQUITOES AND MALARIA. 233 

a more absurd statement than that because one has gone on doing 
wrong, one has more sense than a person who has done an operation 
and has discarded it as worthless. Hernias have frequently occurred 
from Alexander's operation, and authorities in New York City have 
placed on record between forty and sixty cases, and I have never heard 
these cases disputed. It is better to let retro-displacements alone than 
to produce one or two hemiae. The mere mention of Goldspohn's 
name upholds all that I have said on diagnosis. Goldspohn opens the 
rings into the abdominal cavity, and goes down into the pelvis and 
treats disease on both sides. His operation is entirely different than 
Alexander's, and violates every principle of Alexander's, and is conse- 
quently far superior. His work is very valuable; but why make the 
double opening when one opening in the median line will do. I 
admire Dr. Noble's ability to treat these cases without overlooking 
complications. I have struggled for years to do so, but I have been 
unable to reach the point which Dr. Noble claims he has reached. I 
know, however, that the only cases Dr. Noble was sure of were those 
in which he opened the abdomen. 



Mosquitoes and Malaria. 

BY J. J. KINVOUN. M. D., PH. D., GLENOLDEN, PA. 

The only excuse the writer can offer for this brief paper is that now 
since malaria has become a household word, and has also become, as 
it were, safe refuge for many of us when in doubt, it will not be amiss 
to note the progress which has been made in the etiology of this dis- 
ease, and in particular to the role which the mosquito plays in the 
transmission from person to person. 

It is now a little over two decades ago since Laveran described the 
parasite, and since then our knowledge regarding its behavior and 
life history was added to little by little. However, as valuable as 
these discoveries have been, little or no progress was made in deter- 
mining just how and in what manner this parasite gained entrance 
into the body and caused the train of symptoms which we ascribe to 
malaria. 

Of the ten known species of hamamoeba affecting vertebrates, 
only three* are classed as affecting man. 



*Since the above was written, a hamatozoan has been described as being (he 
cause of spotted or mountain fever, and a mycoid body in certain cases of remit- 
tent fever. 



234 MEDICAL SOCIETY OF NEW JERSEY. 

Laveran believed the malarial parasite to be one species, while Golgi 
asserts that these are at least two, if not three or more ; Celli recog- 
nizes three — the benign quartan and tertian, the malignant tertian or 
aestivo autumnal ; while Manson describes five—quartan, tertian 
(benign forms which do not form crescents), the quotidian pigmented, 
quotidian unpigmented, the tertian — all malignant for crescents. 

The plurality of species of the organism is further confirmed by 
Mannaberg's experiments, in which he inoculated thirty-three persons 
with blood from cases suffering from malarial fever, and produced in 
every instance the same type of the organism as were found in the 
blood of the original cases. 

The inoculations made by Bignami and Grassi with blood of a 
patient containing the tertian parasite also confirms this view. The 
experiment conducted by Sambon and Low is perhaps of greater 
importance than any of the above cited. These gentlemen, while at 
Ostia, fed mosquitoes on the blood of a case infected with the benign 
tertian parasite and sent these to England, where Doctor Thorboume 
Manson submitted himself to be bitten by these mosquitoes, and five 
days afterwards came down with an attack of_the tertian fever. 

In regard to the plurality of species, the writer has believed for 
many years that the contention of Laveran and others was incorrect, 
and based this belief on the observation of several hundred cases of 
malarial infections, treated at the Marine Hospital at New York in 
1889 to 1890. In the study of the bloods of cases the morphology 
and development of the parasite was such as to suggest that there 
were two, if not three, species, the tertian, aestivo-autumnal, and 
another unclassified, now recognized as the quartan. While our 
views were convincing to ourselves, and not to others, they were not 
given more publicity than the occasion required. 

Various theories from time to time have been advanced to explain 
how malaria was contracted. Among the oldest is that the mosquito 
is one of the agencies of transmitting it to man. In olden times it 
was held by several authors that malaria could be transmitted by the 
stings of insects. Varro described the mode of infection by inhaling 
or swallowing a small animal which grew in the marshes. But it was 
usually regarded as a miasm, as the name indicates. 

There were also popular beliefs regarding the mosquito being 
causative of malaria. The natives of East Africa have long asserted 
that it was caused by its sting ; in fact, their name for malaria was 



MOSQUITOES AND MALARIA. 235 

" mbu," the same as for mosquito (Koch). The natives of certain 
districts of India, where malarial diseases prevail, always slept with 
the whole of their bodies and heads covered to ward off malaria. 

"The peasants of the Agro Romano always fumigated their cabins 
before occupying them, for the purpose of driving out the mosquitoes, 
believing that if they did not they would contract malaria " (Celli). 

In this country the belief is held '* that to go out after sundown one is 
almost sure to catch the chills." Nott, in 1 848, speaks as if the mosquito 
theory was an accepted fact. To King (1883) belongs greater credit 
than to any other for the mosquito theory and his arguments therefor. 
Then follows other theorists, Lavaran and Flugge. 189!, Koch, 1892, 
Manson. 1894. Mendini, 1896, who drew an analogy between the 
mosquito in its relation to Filgaria sanguins hominis, and the possi- 
bility of malaria being contracted in the same way. The most 
important of all are the facts adduced by Ross, 1898. by which he 
demonstated that bird malaria was infectible through and by the 
mosquito. 

Ross's researches on the proteosoma infection of birds were of such 
as to suggest the mosquito being the agent in transmitting human 
malaria. In order for a better understanding of the importance of 
Ross's discoveries, it may be well to refer to these a little more in 
detail. In 1898 he took 245 gray mosquitoes (Genus culex); which 
were allowed to feed on birds which were infected with proteosoma. 
178, or 72 per cent., consequently contained certain pigmented cells 
in their stomach walls. 249 other mosquitoes, used as a control to 
the above, were fed on men infested with aestivo-autumnal parasites 
(crescents) on immature tertian, on birds with halteridum infection, 
and on healthy sparrows. All were negative. But 81 mosquitoes 
fed on mature proteosoma, 76 showed pigmented cells. 

His further observations were that these pigmented cells, after 
being lodged in the muscular walls of the mosquito's stomach, 
became nucleated, began to enlarge to three or four times its size, and 
after a lapse of from six to eight days these nucleated bodies became 
further subdivided into " germinal rods " when the corpuscles burst 
outwards, setting free the rods, which were taken up by the body 
fluids, and finally were found in the salivary gland. Birds bitten by 
mosquitoes after a lapse of from six to eight days (the time required 
for the parasite to complete its sexual development) they would almost 
invariably be infected. 



236 MEDICAL SOCIETY OF NEW JERSEY. 

Another interesting feature was by feeding a mosquito ; on several 
occasions there would then be several crops of the organism develop- 
ing in their various stages. 

Many of the Ross experiments with regard to malaria, however, were 
negative, but he finally found a few mosquitoes belonging to a partic- 
ular species (anopheles), which, after having been fed on malarial 
blood, there were observed, after four to five days, pigmented cells in 
the stomach wall which he had not observed in non-infected insects. 
After finding the proper mosquito it was then an easy matter to 
observe the development of the parasite through its various stages. 

Grassi and Bignami who had been working on the same lines as 
Ross, determined the species of the mosquito prevalent in districts 
where malaria prevailed, succeeded after a second attempt in infect- 
ing persons through them. 

MacCallum and Opie in 1897 and 1898, made researches on the 
proteosoma and Halterdium infection of birds, the latter, the aestivo- 
autumnal infection in man. and discovered that the parasites possessed 
two forms — one a pigmented cell which became flagellated soon after 
its removal from the body, within fifteen to twenty minutes, and 
another in which the pigment was distributed in a definite ring, not 
diffused. The flagellum concentrated its pigment at one end, dashed 
into one of the large granular pigmented spheres which seemed to 
throw out a pseudopodum to meet it, buried its head, finally wriggling 
its whole body into it. Soon thereafter the body became round and 
quescent. Here he was able to observe practically what occurs in 
sexual forms of the malarial parasites, when taken into the stomach 
of the mosquito. 

His interpretation of these phenomena was that the two forms 
found in the blood of birds were the male and female elements, and 
this process was that of sexual conjugation. Following these obser- 
vations, he examined human blood containing the aestivo-autumnal 
parasite, and was able in two instances to observe a conjugation of 
these bodies, which occurred within a few minutes after the blood 
was taken. 

The question would then naturally suggest itself, whether conju- 
gation of these male and female elements can or does take place 
under some circumstances in the human and bird species, and is not 
altogether dependent upon an intermediate host. 

The malarial parasite, like the coccidia, requires a host to complete 



MOSQUITOES AND MALARIA. 237 

Its cycle of development, being parasitic to man, and to a certain 
genus of mosquito anopheles. It has two cycles, the asexual cycle 
(Golgi), endogenous, and the sexual cycle, exogenous (Ross). The 
endogenous mode of reproduction is one of spore formation and can 
be carried on for a period more or less long without the agency of 
the mosquito. The other, the exogenous, is a sexual process which 
can only be completed by the passage through a definitive hose, the 
mosquito. The endogenous cycle of the parasites is completed in 
from twenty-four to seventy-two hours, according to the class to 
which it belongs. 

In general, if blood of a patient be examined shortly after, some of 
the red cells will contain small, actively motile amoebula. and at the 
end of twelve hours, these have increased considerably in size, often 
occupying as much as a third of the corpuscle. It now contains a few 
granules of pigment. At the end of twenty-four hours the amoeboid 
movements are less active, gradually becoming less active, the 
pigment becoming more concentrated, the body now segments, 
(sporocytes), and it destroys the blood cell and is ^et free in the 
plasma. The time required for the sporulation is for the quotidian, 
twenty-four hours; tertian, forty-eight hours; aestivo-autumnal, forty- 
eight hours, and quartan, seventy-two hours. 

The number of sporocytes formed in each segmenting are : tertian, 
fifteen to twenty-three, aestivo-autumnal five to twelve, quartan six 
to fourteen. 

In addition to the sporozytes. the aestivo-autumnal form the well- 
known spheres and crescents after six to eight days, the large 
pigmented spheres in benign tertian in from one to two days. These 
two latter are the forms of parasites which seem necessary to 
complete the exogenous sexual cycle. 

According to Sambon, the formation of the asexual spores during 
the swarming stage, is analogous to the products of zoospores in 
various protophytae. The segmentation of the parasite is the result 
of the exhaustion of nutrition, the process being in all manner and 
purpose the same as parthogenesis in certain of the aphides. These 
insects may produce this by parthogenesis throughout the summer 
season, but at the beginning of the cold season, male and female 
develop, conjugate for the perpetuation of their existence through 
an tgg which will withstand the rigors of the winter. This naturally 
raises the question whether conjugation of the male and female 



238 MEDICAL SOCIETY OF NEW JERSEY. 

elements of the malarial parasite take place within the body, and 
whether this does not occur under certain circumstances, as it is a 
well recognized fact that many cases of malarial infection terminate 
into recovery or a stage of latency, even when no anti-periodics are 
administered. The apparently recovered person may be subjected to 
another attack at weeks, or even months duration afterwards, when 
the blood, immediately after withdrawal, if examined, will contain 
both the male and female elements, that is to say, the flagellated 
and the large pigmented bodies. Under these circumstances, it is 
not an improbability that the parasite may complete its asexual 
cycle within the body. 

Many anopheles, evidently do not transmit malaria, or may be 
capable of doing so under some circumstances and not under others. 
Ross contributes his failures, probably due to climatic conditions, 
although it must be said that the anopheles Rossii, which is the 
most numerous in some places, have not been able to be infected 
with the malarial parasite. Buchanan's observations on quartan ague 
by the bite of the anopheles are as follows : 

*• From the observations now on record, it would be inferred that it 
does not always follow that mosquitoes are easily infected, and that 
in many instances fails. This may be partly due to the mosquito in 
being in proper condition to receive the parasite, or more probable, 
the parasite is not in the proper stage of development for conjuga- 
tion." Grassi believes that the sexual elements may undergo a 
parthogenesis and may not be in condition to furnish the male and 
female elements. 

Further, he says there are persons whose blood does not allow the 
fertilizing forms to develop, and, therefore, are incapable of infecting 
the anopheles. 

Liston {Indian Medical Gazette, April, 1902) summarizes the 
matter thus : 

1. The man experimented on might be immune. 

2. The anopheles did not bite at the time when the parasite was 
in a suitable condition. 

3. The season was not one in which the quartan parasite could 
develop properly. 

4. The species of anopheles used in the experiment was not the 
correct one. 

When a young mosquito escapes from the tg%, which floats upon 



MOSQUITOES AND MALARIA. 239 

the surface, it is a worm-like larvae. It swims, cats greedily, grow s 
rapidly, shedding its skin several times until it has attained its full 
development of the pupa state, during which it ingests no food, but 
undergoes certain anatomical changes, just as we see in the chrysalis 
stage of other insects. The culex mosquito differs from the anopheles 
in the manner in which it deposits its eggs. These consist of from 
200 to 250 eggs glued together in a boat-shape-like mass, whereas 
the anopheles eggs are deposited separately and are not adherent one 
to another. When examined with a lens the culex egg is seen to be 
rather long and narrow, more pointed at one end than at the other, 
and is attached to other eggs in its long axis — that is to say, the 
broader end of the egg lies next to the surface of the water. The 
anopheles egg appears as an oval body, hardly large enough to be 
detected by the naked eye. It is, like the culex egg, broader at one 
end than at the other. The egg. however, is not completely circular 
in its transverse section, one side being more rounded than the other. 
This allows the egg to float with the rounded side on the surface of 
the water, the more flattened or slightly concave surface being upper- 
most. The appearance somewhat resembles that of a boat, which 
occupies a little more than one-third of each side of the egg. The 
air cells act as a float to the egg. The larvae escapes from the egg 
under favorable circumstances within two or three days. 

Bruno and Galli-Valerio say that the larvas of both the anopheles 
and culex may pass the winter in pools, even when covered with ice. 
but this is of rare occurrence. These larvae are usually those of ano- 
pheles punciopennis, and those of maculatus do not survive. Dry 
eggs of both genus are not affected by freezing. ( Grassi.) 

With regard to a further discussion of the life history of the mos- 
quito and the means of determination of genus and the several species, 
it would not only be long, but encroaching too much on the preroga- 
tive of the entomologists who are far more able to do the subject jus- 
tice than the writer. 

Only this general statement will be made relative to the breeding : 
The anopheles seems to prefer pools of fresh water, running streams, 
water in growing plants ; whereas the culex will deposit her eggs on 
anything that contains sufficient moisture to hatch them. 

The period of incubation in the several forms of fever, according to 
Caccini, states, for the tertian is from five to eighteen days, aestivo- 
autumnal five to nine days, malignant tertian five to nine^days; 
the quartan has not been determined. 



240 MEDICAL SOCIETY OF NEW JERSEY. 

Latency, — Malarial infections may appear to have a period of 
latency for a few days, which may extend over many months. This 
latency may be to all intents and purposes the same as a symposis 
and may resemble the symbiosis of the parasite of Texas cattle fever. 
The exciting causes of malarial fever attacks may be fatigue, trauma- 
tism, sudden chill, foods causing gastro-intestinal irritations, medica- 
tion, change of climate, intercurrent sickness, typhoid, dysentery, 
pneumonia, etc. 

With regard to immunity to malarial infection, it is a question 
whether this actually exists in the same sense as we ascribe the state 
of resistance to other infectious diseases. There may be a limited 
number who are non-infectible. There may be, on the other hand, 
many who harbor the parasite without giving any clinical expression 
of its presence. It was an almost accepted fact that people living in 
a region where malaria is endemic became immune. This applied 
particularly to the natives of Africa living on its western coast. Here 
the adult population appeared not to suffer from malaria ; many of the 
children, however, suffer with malarial infection in all its forms. The 
majority of these, however, are not attacked. 

Koch's observations on both adults and children in East Africa 
showed that the majority were infected with the same species of para- 
site as was fatal to the Caucasian, yet with apparently no ill results. 
There must, therefore, be in a relative sense what is a clinical 
immunity but not actual. In fact, the same state appears to have been 
established in these races as in bovine malaria — a state of symbiosis, 
wherein the parasite can exist within the body for an indefinite time 
without disturbing its equilibrium. 

Not long ago many prominent clinicians were inclined to believe 
that the so-called mixed infections were a misnomer, and that condi- 
tion termed typho-malarial fever was purely typhoid fever. In all 
probability the majority of these cases so termed are typhoid fever, 
but there are cases encountered which are mixed infections— malaria 
and typhoid. The clinical symptoms sometimes resemble malaria 
and at other times those of typhoid. 

If the writer may be pardoned for a slight digression from the title 
of this paper, he would refer to some cases of this character which 
were, it is believed, the first to be recorded. 

Squier, in an article published in the American Journal of Medical 
Science, 1885, discussed at length this peculiar form of fever, and his 



MOSQUITOES AND MALARIA. 241 

conclusions were that it was a distinct tpye of fever, and not one of a 
mixed infection, of typhoid and malaria. In the early part of April, 
1890, 1 reported in the abstract of Sanitary Reports a preliminary 
note of what I termed " entero-malarial fever." Six cases of mixed 
infection were encountered in a series of examinations, over 100 of 
malarial cases, ten occurring during the latter part of 1 899. * * * 

** Connected with this series of malarial cases, several others of mixed 
infection have been encountered, a combination of malarial and 
enteric fevers, presenting clinically some deviations from the general 
course of either disease, and deemed of sufficient importance to 
record. 

No difficulty has been encountered in establishing the source and 
time of malarial infection, but with regard to the enteric infection the 
difficulty has been great. Generally, however, the history was to the 
effect that the patient had remained ashore for some time previous to 
sailing to the malarial districts. This combination of these diseases 
has presented two sets of symptoms dividing the cases into two 
groups : 

1st. Cases in which the symptoms of malarial fever predominate, 
masking the enteric symptoms. 

2d. Cases in which the symptoms of enteric fever are more 
prominent. 

In the first group (2 cases), at the onset of the attack the patients 
presented clinically all the symptoms of malarial fever, remittent, 
giving a clear history of the infection, the attack being characterized 
by a chill followed by fever and remissions, constipation and irritable 
stomach, etc., this chain of symptoms completely masking the graver 
trouble, so that suspicions are not aroused as to the true character of 
the malady until the patients were under observation for four or five 
days, or even longer. On admission, the blood of the patients was 
examined for the malarial organism, which being found in abundance, 
the cases were put in appropriate treatment, ^stivo-autumnal and 
tertian parasites. 

A brief synopsis of the symptoms of one case will serve for both : 

H. M., aet. 23. Was taken sick two days before admission, the 
attack commencing with a chill followed by fever, marked by a remis- 
sion. On the day of his admission he had chilly sensations, then a rise 
in temperature followed by later remission. A careful physical exam- 
ination revealed nothing abnormal except a slight tenderness of the 

16 



242 MEDICAL SOCIETY OF NEW JERSEY. 

epigastric region, and a considerable enlargement of the spleen. The 
bowels were constipated. A microscopical examination of the blood 
was made, and a large number of the plasmodia malarias, aestivo 
autumnal were found free, both in the serum and within the blood 
corpuscle. This established the diagnosis of malarial fever of the 
remittent type. On the fifth day after admission there appeared on 
his abdomen several suspicious-looking spots suggestive of enteric 
complication. On the day following, he had slight epistaxis and a 
tendency to diarrhoea, tenderness in the right iliac fossa. At this 
juncture, a bacteriological examination was made of the feces, and 
after several trials a bacillus answering to the description of that des- 
cribed by Eberth was isolated from the stools. An examination of 
the blood at this time demonstrated the presence of the malarial 
parasite, but in greatly diminished numbers. During the next week 
the enteric symptoms became so marked that without any microscopic 
examination there could be no doubt concerning the enteric fever. 
At this time the remissions had ceased and the temperature curve was 
characteristic. 

In the second case (group i). the symptoms were not so pro- 
nounced as in the first, but it did not differ from it on the whole. The 
Plasmodium malarias was found in the blood in abundance, and later 
the typhoid bacillus was isolated from the stools. 

In the second group of cases (three in number), the enteric symp- 
toms were well marked, giving a clear history of the disease. The 
patients had just returned from the South, where malaria was preva- 
lent. The history gave the prodromal period lassitude, etc., followed 
by diarrhoea, epistaxis, and tympanites, and in one case slight hemor* 
rhage. As a matter of routine the blood was examined for the para- 
site, which was found confined in the corpuscle, not free in the blood 
serum tertian. A bacteriological examination was made in each case, 
and the bacillus typhosus isolated from the spleen, thus establishing 
the co-existence of both factors in the disease. 

In one of the cases, during the third week of the attack, when 
convalescence appeared to have been established, the temperature 
being normal and the appetite returned, he had a sudden elevation of 
temperature that rose to 39° and lasted about four hours. The cause 
of this was attributed to some indiscretion, a not an infrequent compli- 
cation during convalescence from enteric fever. In twenty-fours after 
the first attack he had another similar in all respects, which suggested 



MOSQUITOES AND MALARIA. 243 

that the probable cause was malarial. The blood was again exam- 
ined and the Plasmodium found to be present. A return to anti- 
periodic treatment for a few days, and • then the case went on to 
speedy convalescence. The other cases of this group terminated 
fatally, one by peritonitis following perforation, and the other by 
pneumonia. The combination of the two causes appears to have 
produced a more adynamic form than has been observed in other 
cases with like symptoms occurring here during the past two years." 

Prophylaxis. —Th^xt can be no reasonable doubt that the mosquito 
is the sole agent in distributing the malarial parasite, as well as the 
only means by which it completes its oxogenous cycle. The distribu- 
tion of malaria goes hand in hand with that of the genus anophelidat, 
and without it there can be no malaria (Grassi). The existence of the 
mosquito may be denied by the natives, but there is no instance on 
record where it has not been found when looked for by competent 
persons. 

As before referred to. the mosquito as intermediate host is harmless 
unless it has access to the parasite. Koch states that infected human 
beings he considered the starting point of new cases. Only a small 
number of mosquitoes can survive a winter. These must be re-infected 
in the spring. There have been a few advocates of the theory that 
malaria prevails endemically in some portions of the tropics, and is 
independent of the human species. Christopher's and Stephen's 
observations go to show that this is erroneous, particularly so with 
regard to the explorers in the jungles of Africa. They say that there 
are but few places where these are not always near the natives. 

All mosquitoes, even after feeding on infected blood, are not able 
to transmit the parasite to man. Some anopheles are more easily 
infected than others. Some not at all. Frequently the parasite does 
not complete its sexual cycle in the mosquito because the gametes are 
either too young or too old, or even when all conditions are satisfied,, 
its development may be arrested by meteorological conditions. 

Anopheles, however, does not necessarily mean malaria any more 
so than the presence of stegomeia means yellow fever. Nutall has 
already pointed out this fact. Many districts in England are infected 
with anopheles, yet malaria does not prevail. The same has been 
observed in Italy, by Celli, where certain localities are infected with 
malaria, while in others contiguous thereto, anopheles being in abun- 
dance, are exempt. The same has been observed in a locality in 



244 MEDICAL SOCIETY OF NEW JERSEY. 

Northern Michigan, where anopholes have been found, having been 
exempt from malarial infection for years, became infected to a slight 
extent "by a latent case among a gang of railroad laborers. 

The distribution of the several forms of malaria, while dependent 
primarily upon the mosquito, is influenced very largely by climatic 
conditions, which may be in themselves sufficient to prevent the devel- 
opment of the parasite. . The pernicious forms of malarial infection 
are not indigenous to the northern part of the United States, even in 
localities where the benign forms prevail. Many cases of the perni- 
cious tropical malaria were imported into the United States during 
the late Spanish-American war. and from the Philippine Islands, and 
were distributed to nearly every State and Territory, yet notwithstand- 
ing there were no foci originating from any of these. It is. then, quite 
evident that climate must in some way have modified the parasite, 
either in its endogenous or exogenous cycle, that it could not be per- 
petuated. It is more than probable that the modification occurred in 
its endogenous cycle cause secondary cases of the benign tertian as 
occur in these places. 

Shoo suggests as an explanation why certain districts are immune 
to malaria while others contiguous thereto may be infected, may rest 
on the natural food of the mosquito. His observations on malarial 
infection in Northern Holland, in 1902, was to the effect that he was 
unable to infect anopholes when these were fed on acid fruits,«such as 
ripe tomatoes. It mattered not whether the insect was fed before or 
after infection ; but if they were fed upon such as watermelons, sugar 
kept in plain water, they could with appromimate certainty be infected. 

Celli makes a .similar observation regarding the distribution of 
malaria in certain districts of Italy. Some districts are given up very 
largely to the cultivation of tomatoes. The persons living in such are 
free from malaria, whereas those living contiguous thereto, not culti- 
vating these, are infected, the same species of anopheles being preva- 
lent in both places. It has also been suggested that possibly the 
cultivation of the potato, the plant being quite acid, has some bearing 
upon the prevention of malaria in England. Before its cultivation 
became general, malaria prevailed in England quite extensively, and 
now it is extinct. 

Many persons appear to be immune to malaria, and to all practical 
purposes they are so, if one is to judge simply by the clinical mani- 
festations. It was believed at one time that the natives of Africa 



MOSQUITOES AND MALARIA. 245 

were practically immune to malaria, and the negro was nearly so to 
yellow fever. Koch's researches on malaria on the coast of Africa 
show that this immunity is a relative one. He found the majority of the 
negro children were infected, and while the adults were not so much so, 
the children often had fever. Many were to all intents and purposes 
in good health. These parasites were of the same character as seen 
in the pernicious forms of fever occurring in the Caucasian. 

These cases of apparent immunity are those which undoubtedly are 
the cause of perpetuating malarial infection in a given place, or for 
its distribution over wide and separate areas. The great influx of 
foreign population, much of which is drawn from southern Europe, 
where malaria is endemic, furnishes a large number of latent infec- 
tion, and has, no doubt, been the means of establishing new foci as 
well as increasing the infection in places where it had formerly 
prevailed to a slight extent. 

•The management of these latent cases is perhaps one of the most 
difficult problems with which we have to deal in eradicating malaria. 
In the first place, the majority of such cases never come under the 
control of the physician, only when there is a sharp clinical expression 
of the disease. Many know its symptoms so well, that after taking 
a few doses of quinine, they resume their avocations and resort again 
to this self-treatment on another attack. Many others so affected 
pursue the same course, after consulting a physician and do not 
persist in a prescribed course of treatment, sufficiently long to remove 
the parasites. On the other hand, many physicians do not persist on 
a course of treatment which would accomplish this, but are content 
to meet these emergencies as they arise and would appear as in- 
different as to the final termination of the same. 

The efficacy of wholesale administration of the cinchona salts has 
been frequently proven for keeping the infection at a minimum. 
The daily administration of even a small quantity is sufficient for this 
purpose, but it does not always suffice to remove the parasites from 
the blood, nor prevent a reinfection. It has been a time honored 
custom of physicians living in the Southern States to administer 
quinine over a considerable period, and at intervals of about a week, 
commencing a few days after the cessation of the fever, that is to say, 
a full dose on the 7th, 14th, 21st and 28th days. This method has 
recently been advocated by none less than Koch. If such a plan 
could be adopted and made universal, it would not be long before 



246 MEDICAL SOCIETY OF NEW JERSEY. 

the mosquitoes would be freed from infection. Such a scheme, 
however, would fail in its object if we did not provide for the 
control of infected persons arriving from other places, or preventing 
Che importation of infected places. 

It would be next to impossible to maintain this statute because 
of the ever increasing and rapid intercourse between all sections of 
this country, without great difficulty and hardship. While popular 
sentiment would approve of measures to prevent the introduction of 
yellow fever from foreign countries, or in times of an epidemic here, 
from one place to another, it would not aquiesce to an anti-malarial 
measure, unless under some such guise. No radical measures, there- 
fore, could be enforced at the present time, unless there was a 
complete change of popular sentiment regarding the gravity of 
malarial fevers. Quite a number of plans have been suggested for 
the eradication of malaria, the drainage of swamps, the cultivation 
and drainage of soil, changing the nature of the soil, planting certain - 
trees and shrubs to abstract the mosquito therefrom, and personal 
prophylaxis (Celli). 

Koch advocates personal prophylaxis as being the most important, 
while Ross believes in an anti-mosquito campaign and personal 
prophylaxis, /*. e., preventing the mosquitoes infecting pei^ons and the 
isolation of the cases of malaria, so long as they are capable of 
transmitting the parasite to the mosquito. All these plans have to 
a more or less extent been put in execution, and have been of benefit. 
So far, however, none have entirely banished malaria. Draining 
swamps is the oldest plan on record. Empidocles in 460 B. C, 
drained the marshes around Agrgentum for this very purpose. 

Quinine enjoys the distinction of being the universal remedy for 
the prevention, as well as the cure, for malaria. Other remedies have 
been advocated from time to lime, but none have so far approached 
it in efficacy. Probably there may be discovered a better remedy now 
since the etiology of malaria is better understood, and the life history 
of the mosquito is attracting the attention of the scientific world. 

The question as to whether susceptible persons can remain for a 
considerable time in a malarial locality without contracting the disease 
needs no further discussion other than to refer to certain experiments 
of the commission sent out by the School of Tropical Medicine, of 
Liverpool, and those of the Japanese Government. The commission 
repaired to Ostia, a place notorious for its fevers, and remained there 



MOSQUITOES AND MALARIA. 247 

for over three months, during the time of the year when malaria fevers 
were the most prevalent. Its members observed no other precaution 
than guarding themselves against mosquito bites. All escaped infect- 
tion. During this time others coming into this place, not being pro- 
tected, nearly all these contracted malaria. The other instance is the 
experiment of the Japanese government with a regiment sent to For- 
mosa in 1901, at the season when the fever prevailed. Two battalions 
were selected, one was protected against mosquitoes, and the other 
allowed to live under ordinary conditions of camp life. Observations 
were made on these two battalions for over five months. The pro- 
tected battalion escaped from all forms of malarial infection, while 
the unprotected had 259 cases of fever. 

The wonderful success achieved by the U. S. Army during its 
occupation of Havana has no parallel in sanitation. Its first efforts 
was to clean up the city and make it as clean as possible. It was only 
a short time until this was done, for it was a universal belief that the 
reason why. yellow fever constantly prevailed in Havana, was due to 
its filth. Despite the most painstaking and thorough cleansing of 
the city, the military and sanitary authorities were grievously dis- 
appointed on the net results of this work. Yellow fever showed no 
diminution, but on the contrary had prevailed to a larger extent 
than before the occupation. Malarial fevers were also as frequent. 

Just at this juncture, a commission headed by the late lamented 
Walter Reed, began its researches on the etiology of yellow fever. 
Soon after his wonderful discovery became known, that the stegomeia 
mosquito was the intermediate host of the cause of yellow fever, his 
recommendations were adopted and put into effect. The campaign 
was simply directed against the mosquito, sanitation being secondary. 
It was practically a war against the mosquito, both to prevent its 
breeding and preventing its biting cases of yellow fever. Within 
less than one year after this campaign had been instituted, yellow 
fever was eradicated from Havana. The result was, that not only 
yellow fever was eradicated, but the deaths from malarial fevers 
dropped down to almost nothing in comparison to what had existed 
in former years. Havana to-day, enjoys the distinction of having a 
death rate less than any other city of the tropics. The military rule 
of Cuba was, therefore, not only a political Godsend to the people of 
the island, but has been the means of demonstrating to the world 
how yellow fever epidemics can be effectually suppressed. The results 



248 MEDICAL SOCIETY OF NEW JERSEY. 

of Reed's and Carroll's investigations, and their practical application 
by the army almost exceeds belief. They read more like a romance 
than actual facts. 

If now malarial infections could be dealt with in the same forceful 
manner as has been done with yellow fever, it would not be long 
before it would disappear. This does not seem impossible, because of 
its widespread distribution, and of its clinical manifestations. If 
malarial attacks were as fatal as those of yellow fever, and was 
regarded as a serious commerce disturber, probably more drastic 
measures would be taken against it, but so long as the great 
majority of cases are not fatal, there will be a disposition to temporize 
with it. 

An anti-malarial campaign in a city is, comparatively speaking, less 
difficult than one in the country. In one the area is small, in the other of 
indefinite proportions. Whatever is done, is for the purpose of destroy- 
ing the mosquito and preventing its breeding. This requires a large 
expenditure of money. Cities may be able to meet these expenses, but 
country districts cannot, unless largely aided by the State or National 
Governments. Any effective plan for eradicating malaria from a dis- 
trict of considerable area must, therefore, be considered as a public 
work. Many communities may possess the means of improving their 
sanitary condition by engineering the destruction of mosquitoes and 
the control of infected persons, but such instances will be few and far 
between when compared with the majority unable to do so. Even 
were it possible to rid malaria from a given place, it would be a long 
time before the danger of reinfection could be overcome. The rapid 
intercommunication between it and other places by sea and land is 
ever increasing, there is a constant shifting of the population, acces- 
sions to its population are constantly being made to these of immi- 
grants from the malarial districts of Europe — many of these are 
infected — all these tend to perpetuate the parasite. And so far we 
have been unable to abolish the mosquito. We, therefore, naturally 
hesitate in advocating radical measures, nor can we hope for speedy 
success if we consider that an anti-malarial campaign must include 
fifty millions of our population and over a million and a half square 
miles of territory. 

The control of malaria, that is to say, to reduce the number of infec- 
tions to a minimum, will, perhaps, be accomplished within a generation. 
It will demand a constant agitation of the subject, an education of 



MOSQUITOES AND MALARIA. 249 

the masses, and more in particular our legislators, before we can hope 
to accomplish what we desire. If the legislative bodies of State and 
Nation could be impressed with the importance of improving the 
health of our people, and make available for this purpose even a small 
amount of the sums annually expended in protecting the health of 
the live stock, we feel sure that before many years there would be a 
wonderful improvement in those districts now infested with malaria— 
a healthier people, an increased population, and more intelligent and 
energetic citizens. 

We have as a nation been prodigal with our expenditures for devel- 
oping our rivers and harbors, for promoting commerce. There has 
been expended on the Mississippi and Missouri rivers alone, not to 
speak of the smaller, enough money to have constructed them anew, 
and to-day they are practically useless. If only a few annual appro- 
priations could be diverted from these, and be expended in the 
improvement of the sanitary condition of the country, in the drainage 
of malarial swamps, it would have given a greater return than all 
that has been wasted under the guise of promoting commerce. 

In this connection, another thought suggests itself, that is, the 
employment of the idle labor in this public improvement. There are 
now many thousand able-bodied men wandering over these United 
States, having no settled abode, no employment, and seeking none. 
The tramp does not starve, some one, therefore, must feed and clothe 
him and care for him when sick. Now, in view of the fact that the 
public cares for him, he should be compelled in return to render a 
quid pro quo for his maintenance. No better plan could be suggested 
than to put him to work digging ditches, draining swamps and eradi- 
cating mosquitoes. The inmates of our penal institutions should be 
utilized in the same manner. These are cared for at the expense of 
the taxpayer, and many times by those who live in malarial districts. 

The employment of this class of persons on such public works 
would certainly be more humane and less cruel than to pen them up 
within four walls and keep them in idleness. 

DISCUSSION. 

Dr. judson Daland, of Philadelphia.— I think we are all con- 
vinced of the importance of this subject of mosquitoes and malaria. 
The demonstration just made more than ever convinces us of this 
great truth. Despite this there are many unexplained facts, and 



250 MEDJCAL SOCIETY OF NEW JERSEY. 

although I am not able to state exactly what are the other methods 
of transmission than the mosquito. I am convinced that while the 
mosquito is the most important factor, it is not the only one. I 
entirely concur with the reader of the paper that there is one form of 
the parasite for the ordinary tertian variety, that there is another form 
producing the quartan variety, and that there is a third variety caus- 
ing the aestivo-autumnal form. I believe there is also another, which 
explains those malignant malarias which occur on the Isthmus, in the 
neighborhood of Batoum, on the Black Sea, and in various portions of 
the tropics. The method by which this disease propagates itself 
within the body is a matter of considerable interest. A few years 
ago we made some observations on the ordinary type of malaria at 
the Philadelphia Hospital. They were cases of double tertian, and were 
observed almost hourly from the beginning of one paroxysm to the be- 
ginning of the second paroxysm. In the first place, there was great 
difficulty experienced in recognizing the flagellate form ; they were seen 
but rarely. The sequence of events was somewhat as follows : The 
first recognizable element was a very tiny body which might be called 
a spore or a minute amoeboid mass. The next step appeared to be 
the attachment of this body to a red blood corpuscle. The next step 
was the penetration of the corpuscle by this minute body into the 
stroma of that body. The next step was the gradual enlargement of 
this mass, which was at first transparent. As the parasite slowly 
increased in size, one saw first very fine particles of a dark color, and 
these later became larger, and the amoeboid body also increased in 
size until the latter nearly occupied the whole interior of the red 
blood corpuscle. At this time was also observed the curious move- 
ments in the pigment. I mention these points because you will use 
the malarial parasite more especially for diagnostic purposes. These 
pigment particles have a peculiar up and down movement, which is 
very rapid. After this point is reached, the envelope of the red cor- 
puscle breaks and the organism is free in the blood. Later on we 
observed that this entire protoplasmic mass disintegrated into what 
may be called spores, at any rate, spheroidal masses of varying diam- 
eters. The malarial parasite evidently fed upon the stroma of the 
red blood corpuscle, and in doing so took up the haemoglobin, and con- 
verted it into the pigment particles already referred to. This pigment 
was afterward set free into the plasma of the blood. We also observed 
certain other peculiarities in certain cases which were interesting. 



MOSQUITOES AND MALARIA. 2$ I 

Sometimes, for some unknown reason, the malarial parasite would 
penetrate the red blood corpuscle, and on one side the parasite would 
be within the corpuscle and a liny stream would pour out until per- 
haps one-third of the parasite was outside of the corpuscle. Then 
the stream would break, and a pigmented malarial body would be 
found floating freely in the blood. We have also observed in the 
mature pigmented malarial body a multiplication by division. This 
was clearly observed in one particular case of which I have drawings. 
It is known that in the quartan variety the pigment is very small and 
tends to assume a ring form. Frequently in certain of the fatal cases 
there is some difficulty in making out the malarial parasite. Strangely 
enough, in the southern part of Russia these cases are said to closely 
simulate typhoid fever. Professor Gurko, of Tiflis, a celebrated clin- 
ician, stated that, in his opinion, the differential diagnosis was only 
possible by a microscopical examination of the blood and the discovery 
of this parasite. 

We in the north know that typhoid fever is at times complicated 
by another infection, /. ^., malaria. I have, myself, seen this double 
infection, more particularly among the returning soldiers from Porto 
Rica and Cuba. In one case, the malarial body was easily discovered, 
but very quickly the malarial manifestations subsided and the 
symptoms of typhoid fever developed, while still later, these symptoms 
subsided and the symptoms of malaria again came to the front 
coincident with the reappearance of the parasite in the blood. It is 
not at all inconceivable that when there is a typhoid infection, that 
the resulting fever and other changes that take place, so alter the 
the blood that it no longer possesses the conditions necessary for 
the proper development of the malarial parasite. 

The question of latency and immunity are of great interest. Dr. 
Kinyoun has spoken of people in Africa evidently showing indi- 
cations of immunity. It is unquestionably true that many of the 
blacks on the African coast have malaria, so far as the presence of 
the parasites are concerned, and yet present no symptoms ; but if a 
band of 200 were taken to the mountain-tops, many of this number 
would develop unmistak^le symptoms of malaria. I think that we 
may say that these persons have a latent form of malaria ; they are 
not really immune. These facts are well known to the natives, and 
hence they are disinclined to make the ascent of mountains. 

Prophylaxis has been dwelt upon at considerable length by Dr. 



252 MEDICAL SOCIETV OF NEW JERSEY. 

Kinyoun. The most important points are not only the destruction 
of the anopheles quadralatus, but also the protection of the community 
from mosquitoes which have become inoculated from existing cases. 
It is, therefore, a wise plan to insist that cases of malaria are not 
permitted to be attacked by mosquitoes. 

Dr. Evans. — I have nothing to add of interest to this discussion, 
nor am I in a position to discuss it from a strictly scientific stand- 
point ; but I should like to mention one fact. In Alabama, according 
to reliable information, there is what is known as "the black belt." 
and I am assured by Dr. W. P. Spratling, of the Craig Colony for 
Epileptics, and by a number of residents of Alabama, that in this 
swamp there are no mosquitoes, yet in all this region, the most 
malignant forms of malaria exist and death from it are quite frequent. 
The reference made by Dr. Kinyoun to the experiment on the island 
of Formosa, was very interesting to me. and when taken in connection 
with the fact I have just mentioned. I am at a loss to understand 
the situation and would like to have more light thrown upon it. 

Dr. C. p. Noble, of Philadelphia. — As a gynecologist, perhaps 
you do i^ot expect me to know anything about malaria, but it so 
happens that I was born in a malarial country, and have suffered 
from the disease myself. That region was very malarious, and in 
wet seasons the entire profession would be overworked. In that 
region to-day there is practically no malaria. The country is very 
low, the highest point of land within fifty miles being not over fifty 
feet above the sea-level, a great deal of it being only from five to 
ten feet above that level. The doctors in that vicinity attribute the 
disappearance of malaria to the fact that the old-fashioned wells have 
been given up and driven wells have been substituted. In my native 
town there has been absolutely no change in the physical character- 
istics, except that artesian water has been substituted for well water. 

Dr. Marcv, of Riverton.—This is a subject which is attracting 
considerable attention in our Society. As has just been said, our 
State Entomologist, Professor J. B. Smith, is investigating this subject 
very thoroughly, and has made some very practical recommendations 
for the destruction of the mosquito. There' is a commercial side to 
this question, leaving out altogether the sanitary aspects. Large 
tracts of land in this State are practically uninhabitable from the fact 
they are in such condition that mosquitoes breed in enormous numbers 
and people cannot live there. It is quite within the bounds of pos- 



MOSQUITOES AND MALARIA. 253 

sibility that these lands may be so drained and restored that they 
may become not only inhabitable, but very productive. The mosquito 
is certainly an intermediary host» but there are undoubtedly other 
methods for the propagation of malaria. Some months ago I had 
the good fortune to be near the Black sea, where malaria is. most 
malignant. In the military hospital there, almost every patient had 
a severe type of malarial disease. I found that mosquitoes were 
not very prevalent ; hence the mosquitoes there must be very much 
over-worked, or else there is some other method of transmitting 
malaria. The practical side of the question should be taken into 
consideration by us all. Every one present, on going home, should 
see to it that his patients understand that if buckets of water or 
rain barrels are left exposed, an excellent breeding place will be 
provided for mosquitoes. While no doubt the anopheles have most 
to do with the propagation of malaria, the culex certainly causes us a 
great deal of suffering and makes a good deal of noise about it. 
There is no subject that can be taken up by this Society that will be 
of more genuine value to our State, than this one of malaria and 
mosquitoes, and the means of ridding our State of these pests which 
have become so famous, both in verse and song. 

Dr. C. Sheppard. — I should like to give my own personal experi- 
ence for the benefit of the investigators. For the last forty years I 
have been troubled more or less with malaria. I have had to take 
quinine at short intervals annually during all that time. Mosquitoes 
do not trouble me in the least with the exception of the noises pro- 
duced by the singing variety. If they bite me I do not know it, 
because no visible effect is produced. The other members of my 
family are affected almost as seriously by the mosquito as by decidedly 
poisonous insects. About two years ago I was suddenly seized with 
what I supposed to be malaria. I had a violent shaking chill, which 
lasted one hour, and was followed by a hot stage of one hour, and 
then by the stage of perspiration. The last had barely subsided 
when the chill was renewed, and was followed by a hot stage and a 
stage of perspiration. This continued successively from Sunday 
afternoon until eleven o'clock on Tuesday. At one o'clock an attack 
of hiccough set in and lasted for nearly two weeks with but slight 
intermissions. There was no pain, but vomiting was very distressing, 
and was thought by some physicians to be due to gastritis. My own 
opinion is that the vomiting was entirely due to the effect of the chills 



254 MEDICAL SOCIETY OF NEW JERSEY. 

upon the nervous system ; for as soon as the hiccoughs ceased the 
vomiting ceased, and I recovered without further interruption. I 
should like to know whether those chills were produced by mosquitoes, 
or was the attack one of malaria arising from some other source. 

Dr. E. B. Silvers, of Rah way.— Having lived in a malarious district 
all my life, I have been taught some valuable lessons. We know 
that we can tolerate a great deal of malaria, and that when we leave 
a malarious locality and go for some time into one free from malaria, 
that we develop chills and fever. I have known of many such 
instances. If we live in an intensely malarial district and become 
acclimated to it, it is presumable that our resistance power increases. 
I have had occasion, professionally, to visit Rahway Neck, where 
mosquitoes are both numerous and virulent. My horse at each trip 
losing pounds of *' liquid flesh." My patients urged me to locate 
there. I told them if they gave me a thousand acres I would not 
live there owing to the pest of mosquitoes. They facetiously replied 
that "after a year's sojourn, I would not mind them, as I would be 
pierced full of holes, and then these mosquitoes would go in the old 
holes and I would not mind them." 

Around my residence I have tried to raise plants that were con- 
sidered obnoxious to mosquitoes, particularly pennyroyal and the 
California castor oil plants, with no practical results. I have been 
told that in some parts of South America they have planted around 
their abodes, plants that were protective. The names of such I 
have forgotten. In our city we have found that the removal of our 
dams, reclaiming large tracts that were formerly occasionally sub- 
merged, good sewers and clean back yards— in a word, good hygienic 
laws, faithfully observed, are the best prophylactics against both 
malaria and mosquitoes. 

Dr. Armstrong, of Rutherford. — In our meeting two years ago 
at Deal Beach I read a paper in which I touched upon this subject. I 
am very glad that Dr. Kinyoun has advocated in this paper the educa- 
tion of the people with regard to. this matter. I suggested at the 
time that a committee be appointed to carry on this work of educa- 
tion, but that committee was not appointed. The commercial aspect 
of this question should not be lost sight of, for, I believe, the depre- 
ciation in value of lands is exceedingly great. The theory advocated 
as to the propagation of malaria by mosquitoes I believe to be correct. 
The question of susceptibility seems to play an important part, just 



MOSQUITOES AND MALARIA. 255 

as it does in other diseases. We know very well that every one 
exposed to scarlet fever does not contract that disease, so it seems to 
be a question of soil as well as inoculation. 

Dr. Kinyoun. — With regard to the malignant fevers referred to 
by Dr. Evans, I would say that this form of fever occurs all along the 
Atlantic and Gulf coasts from Norfolk, Va., to beyond Galveston, 
Texas. The anopheles mosquito has been found in all the localities 
in which these malignant fevers have occurred, I, therefore, cannot 
offer any explanation of the cases of fever referred to in Alabama, 
save that a careful search has been made for the anopheles. 

Another manifestation of malarial fever is that complicated with 
haematuria and jaundice, the so-called " black water fever." There 
is yet a diversity of opinion as to the exact cause of these fevers. The 
majority of observers hold that it is due to the malarial parasite, while 
Koch, Sambon and Yersin believe it to be due to some other cause 
than the malarial parasite. Certainly the malarial parasite is found 
in the majority of these cases, particularly when the examination is 
made in the earliest stages of the disease. If the contention of Koch 
is correct, then there must be a mixed infection ; that is to say, the 
malarial parasite associated with the cause of the " black water fever." 

I am more and more impressed with the idea that the day is not 
far distant when we must accept the theory of the plurality of species 
of the malarial parasite. Many of the pernicious malarial fevers 
observed in Africa, the West Indias, Central and South America, 
appears to me to be due to a different species of the parasite than 
those observed in this country. Certainly one would be led to believe 
that this is a fact when examining cases of pernicious malarial 
fever occurring in Cuba. Probably we will find on further observa- 
tion an explanation of the reason why the so-called " black water 
fever " affects only certain localities while in others it is not found. 
Possibly there is a species of parasite which is transmitted to man by 
some other insect or agency than the anopheles. 

In answer to Dr. Marcy's inquiry, I would say that at one time I 
was a firm advocate of the water-bom theory of malaria, but in view 
of the recent researches, I have been compelled to abandon it. Per- 
sons living in a malarial locality are not always the best witnesses in 
establishing the habitat of the mosquito. Some deny their presence 
from local pride, and others simply from the fact that they have 
become so accustomed to the mosquito bite that they pay no atten- 



256 MEDICAL SOCIETY OF NEW JERSEY. 

tion to it. In many instances, I have made inquiries of persons 
living in mosquito-infected countries, whether or not the jnosquito 
troubled them, and have received a negative answer. Many of these 
have claimed that mosquitoes would not bite them, yet on a casual 
observation I have seen as many as seven or eight mosquitoes feeding 
on their hands or face without their apparently noticing it. 



Clinical Contributions to the Knowledge of 

Tubercular Disease of the Female 

Urinary Tract. 

BY EDWARD J. ILL, M. D., NEWARK, N. J. 

It is with some hesitation that I bring the subject of tuberculosis 
of the female urinary tract before you. I do not mean to treat it in 
a didatic way, but rather, as the title of my paper reads, in the 
form of a clinical contribution. 

Within the last thirteen years, since I began the study of these 
cases, the experience gained has been a rather wide and varied one. 
Some cases have been followed for years, and records of their con- 
dition kept. The disease is comparatively frequent and is rarely 
diagnosed as such. Very few cases that have come under my 
observation, have been sent with the diagnosis of a tubercular lesion. 
In other words, the family physician has recognized the disease only 
exceptionally. The subject is a large one, and if I have succeeded 
in drawing your attention to this severe illness and especially to its 
early recognition and frequency, the object of this paper will have 
been attained. 

It has been said that one-half of all inflammations of the bladder 
are tubercular. If that is a fact, I wish to say that by no means one- 
half of the cases can be proven so by the finding of the tubercle 
bacillus, and no diagnosis is complete until the specific bacillus has 
been found. 

The finding of the bacillus is not always an easy matter and 
much time may have to be spent in the search. Two things must 
be plainly understood in this connection. First, there is no pyelitis 
or cystitis without an infection, and, second, there is no pyelitis or 
cystitis without pus or the copious shedding of mucous membrane 
elements. I say this because the diagnosis is often made when there 
is not the slightest trace of pus in the urine. 



FEMALE URINARY TRACT. 25/ 

The origin of tubercular inflammation of the urinary tract is most 
frequently in the pelvis of the kidney or in the kidney itself. Thus 
far I have seen but one case (Case ii), where the beginning of the 
disease may have started in the bladder. The following case of the 
disease of the pelvis of the kidney could here be cited : 

Case /. — Tubercular inflammation of the pelvis of the right kidney. 
Hematuria. Nephrectomy. Cure. 

Mrs. A. M., married ten years, age forty-four years, has been in 
poor health since she ceased menstruating three years ago. She 
entered St. Michael's hospital on January 22d, 1903. Since November 
24th. 1902, has been passing bloody urine constantly, has had much 
back-ache and nausea and a constant pain in the right loin, worse 
when setting down. This has reduced her so much in health that 
she looked for help. Medication had no effect on it. A catheteri- 
zation of the ureters showed that the blood came from the right 
kidney. No tubercle bacilli were found, though repeatedly looked 
for by the bacteriologist. A malignancy of the right kidney was 
suspected. An exploratory operation was done on January 29th, 
and the kidney drawn out of the wound. It was rather a small 
organ. The pelvis of the kidney felt as though it contained a foreign 
body and was opened by a longitudinal incision. A very firm 
blood clot was all that was found. 

The fear of continued hemorrhage prompted the removal of the 
kidney, which with two inches of the ureter was sent to the pathol- 
ogist of the hospital. Dr. Teeter. He reported tubercular ulcerations 
in the pelvis of the kidney eroding some of the blood vessels. 

The patient thus far remains well and is much improved in 
health. 

Not only does the resistance of the bladder to the tubercle bacillus 
seem great, but the bladder will readily throw off the disease as soon 
as the original focus has been removed, as is shown in the following 
cases : 

Case 2, — Tubercular left kidney and ureter; extensive tubercular 
ulceration of the base of the bladder ; nephro-ureterectomy ; recovery ; 
normal bladder at this date. 

Four years ago I presented to this Society the specimen and 
report of the case of Miss P., a seamstress, aged twenty-seven. 
She was sent on April 27th, 1899, by Dr. £. DeL. Brandin, because 
for more than a year she suffered from more or less pain in the 

n 



258 MEDICAL SOCIETy OF NEW JERSEY. 

left lumbar region, not severe enough to incapacitate her until a 
month ago. About February ist, 1899, she also began to have 
frequent and painful urination, lost strength and flesh. She passed 
water every twenty or thirty minutes and was up and down day 
and night. Dr. Bradin soon discovered that she had pus in her 
urine as well as tubercle bacilli and connective tissue particles. 
The number of bacilli in the urine was very large. 

An examination disclosed a very thick left ureter and several 
tubercular ulcerations at the base of the bladder and at the opening 
of the left ureter. There was slight rise of temperature, but no 
hectic. 

On May 24th, 1899, the left kidney and ureter were removed. It 
was found that she had a cheesy abscess of the kidney as large as a 
walnut and the ureter was so much thickened that the lumen was 
nearly obliterated. She rapidly got well. For about three months 
tubercle bacilli were occasionally found in the urine and since then 
she has remained well, having been married a year after the oper- 
ation. At present her urine is normal, as is also her bladder. 

Case J. — Tubercular right kidney and ureter ; tubercular ulceration 
at the meatus of the right ureter and its surroundings; nephro- 
ureterectomy; recovery. A normal confinement within eighteen 
months after the operation ; normal urine at this date. 

Mrs. S. S., Russian, aged twenty-four years; married, has two 
children and is in good general health. She presented herself on 
June 26th, 1 901, through the kindness of Dr. Parsonette, complaining 
of painful urination. There had been pains in the right iliac region 
for some months. 

Dr. R. N. Connelly found her urine to contain pus, tubercle bacilli 
and shreds of cellular tissue. To Dr. Connelly I am much indebted 
for many favors in these cases. Upon catheterization of the ureters it 
is found that the left kidney is healthy and the right kidney is 
diseased. The endoscope shows the bladder to contain a few tuber- 
cular ulcerations about the right ureter. 

Typical nephro-uterectomy was performed on June 28th, as in the 
foregoing case. The incisions were thirteen c. m. long in the loin and 
nine c. m. long in the right iliac region, leaving a bridge between of 
seven c. m. She made an afebrile convalescence, and was discharged 
cured in twenty-six days. She became pregnant within six months, 
and was delivered by Dr. Parsonette in a normal labor. At no time 



FEMALE URINARY TRACT. 259 

did the urine show anything abnormal during the pregnancy nor since. 

Case 4, — Extensive tubercular ulceration of the right kidney and 
ureter; extensive ulceration of the bladder; nephro-uterectomy ; 
recovery; urine perfectly normal December 4, 1902. 

Miss £. B., aged twenty-two years; single; stenographer, and of 
good family history. She presented herself in fair general health on 
April 6th, 1901, complaining of frequent and painful urination since 
three months, and constant pain in the right lumbar region. On 
questioning, it is discovered that she never eats meat nor drinks milk, 
living on eggs, vegetables and cereals. The pain was so great that 
she was unable to follow her employment. Her urine was found to 
contain thick, heavy tubercle bacilli and shreds of cellular tissue and 
pus. 

The right kidney could not be made out, but the right ureter was 
much thickened and many tubercular ulcerations were present in the 
posterior lower half of the bladder. Catheterization of the ureters 
showed the disease to be confined to the right side. The left kidney 
seemed normal. 

April 9th, 1 901 , operation. Lumbar incision over the right kidney — 
that is, from the end of the last rib downwards and forward for about 
nine centimeters. The muscles were not cut, but all fibers were sep- 
arated. 

The kidney was a large one, and was brought out with some diffi- 
culty. The vessels were ligated with a grad ligature and the ureter 
gradually enucleated so far as the finger could reach. 

An incision of six centimeters was then made at the edge of the 
rectus in the right iliac fossa, parallel with Poupart's ligament and 
down to the peritoneum. The separation of the ureter was continued 
through this opening until its insertion into the blazer was reached. 
It was cut between two ligatures with the caiitcry, and the lower 
stump brought out through the vagina, where it was cut off with the 
cautery close to the bladder after ligating with catgut. 

The very large kidney was found to be filled with milliary and with 
large tubercles and several small abscesses. The ureter was ,ver)r 
much thickened, so as to appear about like a steel sound. No. 36, 
French. 

Both wounds were drained with gauze. On the next day the 
patient's temperature rose to 104'' and the pulse to 140 per minutd 
The wounds were opened all over, but no discharge showed itieH. 



26o MEDICAL SOCIETY OF NEW JERSEY. 

She was given twenty c. c. m. of antistreptococcus serum without any 
result, and went along for some months with a bad septic condition 
of which she eventually recovered and is perfectly well at this date. 
Her urine and bladder were last examined on December 4th, 1902, 
and found to be perfectly normal in every respect. At that time she 
appeared to be the picture of health. 

From the history of these cases it becomes apparent that the dis- 
eased portion of the bladder may regain its health and resection of 
the diseased portion is not a necessity. Even the ureter will appa- 
rently recover, as is shown by'the following case : 

Case s^ — Extensive tubercular destruction of the right kidney and 
ureter. Tubercular ulceration of the bladder. Nephrectomy. Re- 
covery. 

Miss R. W., aged thirty-five years, single, seamstress, of good family 
history ; was sent through the kindness of Dr. Gage on March ist, 
1 90 1. This woman had been suffering for a year from great pain in the 
right lumbar region running down through the right iliac region into 
the bladder. There was frequent and painful urination. On exami- 
nation the urine was found loaded with pus and tubercle bacilli and 
tissue particles. The urine was ammoniacal and gelatinous. Her 
general condition was very miserable. She had night sweats and 
hectic, and was much emaciated. Her temperature reached 102** and 
pulse as much as 120 per minute. 

The bladder was full of tubercular ulcerations and a thickened right 
ureter could be felt. The right kidney was much enlarged and sensi- 
tive, reaching as low down as the crest of the ilium. 

March 5th, 1901, a nephrectomy was performed. There was about 
a pint of foul pus in the kidney, and great difficulty was experienced 
in separating the adhesions. As the patient was in bad shape and 
the operation had to be hastened, the ureter was cut off with the 
cautery about two inches below the kidney. She quickly improved to 
the extent that she was discharged in thirty-four days. 

For over a year, however, she was said to have remained very mis- 
erable with the tubercular disease of her bladder. Within a few 
weeks I have heard from Dr. Gage that she is now in excellent health 
and seemed to have recovered entirely. 

I do not wish it understood, however, that I would advise to leave 
an infected ureter in the patient. I would simply cite this case as a 
proof how much nature will do to throw off the disease when the 
original focus has been removed. 



FEMALE URINARY TRACT. 26l 

It is for this reason, also, that the writer doubts the assertion that 
bladder tuberculosis occurs with any frequency through the blood 
current, but rather by contiguity. Why, otherwise, should these 
patients get well ? 

The early and most frequent subjective symptonns are pain referred 
to the loin and iliac region of the diseased side and later to the 
bladder. In Case i the patient referred the pains to the loin very 
early, while Cases 2, 3 and 4 also showed the later pain in the 
bladder. Now and then they complain of pain along the course of 
the ureter, and this is so severe that I have known the appendix to 
have been removed by a prominent surgeon by misapprehension. 

This symptom would also show that the infection of the bladder 
was a later stage of the disease. 

The pain at urination always means an infection of the bladder. 
The infection is most frequent at the trigonum and at the meatus of 
the ureters. In the old cases when there is difficulty to retain urine, 
after the desire to pass it once comes on, means an infection of the 
neck of the bladder. 

Hematuria should always be looked at with suspicion. While blood 
that comes from the kidney most commonly means malignant disease 
or stone in the kidney, the fact that it may be tubercular, should not 
be lost sight of. The following cases will illustrate the point in 
question. There being but three cases of all reported in this paper 
that showed this symptom. Besides Case i, already cited, I wish 
to draw your attention to 

Case ^. — Tubercular bladder, right kidney and cervix uteri. Hem- 
aturia. Temporary recovery. 

Mrs. L. S., aged seventy-six, single, complained in February 1902, 
of severe pain at urinating, after having had pain in the right iliac 
region for some time. I had seen her on and off for twenty years 
for a movable right kidney. Her urine was examined frequently 
during this time, and on several occasions there was some albumen, 
never any casts, but always a low specific gravity. 

An examination of the urine in February, 1902, showed pus and 
tubercle bacilli in large numbers. In June and July, 1902, she lost 
some blood by the vagina, which came from a tubercular ulcer at the 
cervix. In July there was a sharp attack of hematuria. While in 
the country she improved rapidly, so that in November, 1902, she no 
longer had any discharge of blood from the vagina and no painful 



262 MEDICAL SOCIETY OF NEW JERSEY. 

urination, though small quantities of pus were still found in the urine. 

A relapse of the bladder symptom occurred in April of this year 
and lasted for a month. During this time tubercle bacilli were again 
discovered, but at the present writing she is again in good shape 
and has no trouble with her bladder. 

The following very interesting case is one of hematuria : 

Case d.— Tubercular right kidney and ureter. Exsanguinating hem- 
aturia coming from the right kidney. Right lumbar pain. Nephro- 
ureterectomy. Cured. 

E. C, married, age, thirty-nine years, mother of six children, in 
poor health. Was sent to St. Michael's hospital on November 7th, 
1898, for chronic cystitis, by Dr. Hagerty. Since two years she has 
been unable to retain her urine for any length of time. There was 
much blood and pus in the urine. The endoscope showed the bladder 
to be uniformly red, almost like granulation tissue, but no ulcerations. 

A vaginal cystotomy was done on November 12th, 1898, and the 
bladder drained. There was no blood for a year. On November 
1st, 1899, she was again admitted to close the fistula and to do a 
nephrorrhaphy and appendectomy, she having constant pain in the 
appendix and symptoms referring to the very movable right kidney. 
The fistula was closed by a flap operation. The appendix removed 
through a lumbar incision and the kidney fixed. She was discharged 
well in four weeks, and remained well. Eighteen months later she 
gave birth to a healthy child. 

During the next three years she was very well until May, ;902, 
when she had much pain in the right lumbar region, and of late there 
was a very large amount of blood in the urine. The pain in the right 
kidney was most unbearable ; she would have chills and fever for 
three or four days at a time. Her physician. Dr. Hagerty, again sent 
her to St. Michael's hospital on November 28th, 1902. A search for 
tubercle bacilli was made in vain by Dr. Connelly. She gladly 
accepted the operation of removal of the right kidney, as no blood 
came from the left kidney by ureteral catheterization. A calculus was 
expected. On lifting the kidney out of the loin through the lumbar 
incision, no stone was detected, but an immensely thickened ureter 
which was certainly thought to be tubercular. The kidney with the 
whole ureter down to the bladder was removed. At the present 
writing, on May 17th, the patient is very well, looking after her 
household duties. With seven children to look after, this is no 
small matter. Her urine is normal. 



FEMALE URINARY TRACT. 263 

The diagnosis of tubercular disease of the female urinary tract is 
by no means, an easy one at all times. Now and then it is readily 
made. 

Every case of pyuria should be examined for tubercle bacilli when 
the cause cannot readily be described to some other infection. The 
sensitiveness of the bladder to the touch per vaginum. is an impor- 
tant symptom in vesical tuberculosis. As we pass the finger up 
the anterior wall of the vagina to the cervix, and then direct it with 
its palmer surface forward, to one and then to the other side, we may 
find a thickened ureter. The normal ureters can nearly always be 
felt as very thin cords, converging towards the neck of the bladder 
and losing themselves a little less than an inch above the internal 
opening of that organ. If the finger is placed at the side of the 
cervix and close to it, the outer edge of the finger will correspond 
to the location of the ureter. 

The ureter, when it is thickened and inflamed by tubercular disease, 
becomes a very sensitive cord. 

I will not detain you with the endoscopic appearance of tubercular 
ulcers, suffice it is to say, that in the beginning, the small ulcerated 
surface is surrounded by small blisters, as a fine herpetic eruption 
might appear. 

When these objective symptoms, coupled with such subjective 
symptoms as have already been spoken of, present themselves, the 
diagnosis is absolute. We shall not always be able to find all 
symptoms, and many times will fail to demonstrate the tubercle 
bacillus. In the latter case the diagnosis becomes dubious. 

The prognosis in the tubercular disease of the urinary tract is 
usually considered a bad one. Nevertheless there are cases that 
appear to get well and remain so for years. The following cases are 
examples in question : 

Case /. — Tubercular bladder and right ureter ; pyuria with many 
tubercle bacilli ; apparent cure. 

Miss M. O., aged eighteen years, was seen in 1 891, with symptoms 
bladder trouble, /'. ^., frequent and painful urination. An examination 
of her urine showed many tubercle bacilli and pus, while the bladder 
contained many tubercular ulcers in the trigonum and the right ureter 
was sensitive and thickened. For some years she was under the care 
of the late Dr. Emma W. Edwards, and became very well. Later she 
was married and gave birth to a child. At the present time, twelve 
years after I first saw her, she considers herself well. 



264 MEDICAL SOCIETY OF NEW JERSEY. 

Case <?.— Tubercular right kidney and bladder ; pyuria with many 
tubercle bacilli ; apparent cure. 

Miss F., single, aged thirty, was taken sick with bladder symptoms 
in the summer, 1893. From then on, she had frequent attacks of 
painful and frequent urination, and was often confined to her bed 
with pain. In 1 895 she took up the training as a nurse. On September 
II, 1897, I saw her with Dr. Mead, in an exceptionally acute attack of 
pain in the bladder. The urine was found to contain large quantities 
of pus and tubercle bacilli. Her temperature at that time was 104^ 
and she gave one the impression of being a very sick woman. 

The right kidney was prolapsed and very sensitive. Catheterization 
failed because of the extensive tubercular ulcerations of the bladder. 
For two years tubercle bacilli were constantly found in the urine 
but since three years, the urine appeared perfectly normal. While 
she still has occasional pain in the bladder, there is no pus in the 
urine. 

From 1897 to 1899, she was treated by Dr. Mead, with creosote, 
sandalwood oil and various tonics. Eggs and milk were an import- 
ant part of her diet. At the present time she is suffering from some 
affection of the vocal cords but no tubercular ulcerations are visible. 

The very chronic course of the disease is well illustrated in the 
following case : 

Case g. — Miss D., single, tubercular left kidney and ureter, tuber- 
cular cyststis. treatment a general tonic one, remained about the 
same to this date. 

About September. 1890, 1 saw Miss D., aged twenty-three, a teacher 
by occupation, who in her early childhood had caries of the spine and is 
much deformed. For some months she complained of much and 
constant pain in the left lumbar and illiac r^ion, with frequent urina- 
tion. The pain at times was hardly bearable, and she often took 
paregoric to relieve it. 

An examination showed extensive tubercular ulcerations between 
the openings of the ureters. The left ureter was considerably thick- 
ened, ^he right one less so, and the urine contained an occasional 
tubercle bacillus. 

A general tonic treatment and irrigation of the bladder gave her 
some relief, so that she took up mission work, but had rather a mis- 
erable existence. Her condition gradually became quiescent, and in 
1898 she took upon herself the care of a country home for crippled 



FEMALE URINARY TRACT. 265 

children. Here she lead much of an out-door life, and, at the date 
of this writing, considers herself tolerably well» though I have not 
been able to see her nor examine the condition of her urine. 

These are the only cases I have been able to follow for many years. 
Some cases prove fatal rather slowly, while in others, general tubercu- 
losis soon kills the patient. 

Case 10, — Symptoms of general tuberculosis, followed by tuber- 
cular right kidney and ureter and ulceration of the bladder; death in 
a few years from general tuberculosis. 

Mrs. S. H. was sent to me on October 7, 1897, by Dr. Lewis, of 
Morristown, who kindly gave me the following history : The patient 
had been sick more or less since six months. She complained of 
fatigue, painful and scanty menses, and irregular fever with chills. 
She was anemic and was losing flesh. Three months previous to her 
visit to me she had a slight cough and scanty expectoration, in which 
the bacteriologist could not find any tubercle bacilli. A second 
examination likewise proved negative. 

About this time she began complaining at urination, which was 
painful at the end of the act but not more frequent than usual. With 
this there was some pain in the loins and over the region of the 
bladder. Dr. Lewis reports pus, mucus and occasionally blood in 
the urine at this time. On one occasion she had a real renal colic. 

When seen by me on October 7th, 1 897, the bladder was sensitive 
to the touch, as was also the right ureter, which was much thick- 
ened, so far as the finger could reach. The inter-space between the 
ureters in the bladder was covered with small tubercular ulcerations. 
The urine was kindly examined by Dr. R. N. Connelly, who reported 
tubercle bacilli, pus and fibrous tissue cells in great numbers, besides 
albumen and pus casts. 

Her previous history indicating a general infection, a bad prognosis 
was made and a general tonic treatment advised. Qr. Lewis carried 
this out, giving her besides, for months at a time, creosote. During 
1899 and 1900 it seemed as if she was going to recover. Her 
bladder symptoms were much ameliorated and her general condition 
much improved. But later she relapsed and died from general tuber- 
culosis. Bacilli had been found in the sputum long before this. She 
died in the spring of 1 901, or four years from the beginning of her 
illness. 

The rapidly fatal cases in spite of operation are illustrated by the 
following. 



266 MEDICAL SOCIETY OF NEW JERSEY. 

Case //.—Tubercular right kidney, ureter and bladder, nephro- 
ureterectomy ; recovery from operation ; death within two years of 
general tuberculosis. 

Mrs. E. W., thirty years, married, one child, presents herself on 
October 26lh, 1901 , in very poor health. The family history is reported 
as good. She has had constant pain in the right kidney followed by 
general weakness. She had no cough but there was some suspicion 
of an apex difficulty. The urine was loaded with pus and tubercle 
bacilli. Upon catheterization the left kidney appeared normal. The 
right ureter was much thickened and the bladder covered with tuber- 
cular ulcerations. 

Because of her great suffering and the evident progressive condition 
of the disease, her right kidney and ureter were removed, as in the 
foregoing cases. The ureter accidently was torn off. but was soon found 
again and removed down to the bladder. How much the accident 
may have to do with her general infections I am unable to say. The 
wounds were closed with drainage and the patient discharged in very 
good condition in four weeks. She remained comparatively well for 
some months but then developed a cough and died nearly one and 
a half years later from tuberculosis of the lungs. 

In spite of the foregoing case one can conscientiously recommend 
the operation of nephro- ureterectomy in those instances where the 
tubercular process is confined to the ureter and kidney, or that have 
originated in those organs, as such good results are shown by the 
cases already reported. 

That cases do get well or at least remain quiescent is unquestionable. 
When operation is counter-indicated, such treatment as is recom- 
niended for tuberculosis elsewhere, should be instituted. Among 
those, fresh air, plenty of water, good, easily-digested and wholesome 
food, tonics and such medicine like creosote, cystogen and cod liver 
oil find a useful field. 

To finish a report of all my nephro-ureterectomies, the following 
two cases are herewith appended. 

Case 12. — Tubercular left kidney. Ureter and bladder. Nephro- 
ureterectomy. Recovery from operation. 

I. M., presented herself at the suggestion of Dr. Charles Young, on 
February I2ih. 1903. She was seventeen years old. single, was well 
heretofore, except when sick with typhoid two years ago. She also 
had albumen in the urine at that time. She began to have pain in 



FEMALE URINARY TRACT. 267 

the left lumbar and iliac region, which she dated from a fall in 
September, 1902. The pain gradually extended down into the left 
iliac and vaginal regions. Soon there was a constant inclination to 
pass water. She gets up from three to seven times during the night 
for that purpose. An examination revealed that she had retro-left 
lateral position of the uterus, a very much thickened left ureter and 
that her urine was loaded with pus and tubercle bacilli. The right 
ureter was catheterized and nothing abnormal discovered. On 
February 26th, a nepho-ureterectomy was performed. Unfortunately 
she became septic, but soon recovered from the acute symptoms 
after the use of Dr. R. N. Connolly's anti-toxin serum and a wide 
opening of the wound. There was left a fistulous tract in the 
latter part of May. At the same time she gained flesh rapidly in spite 
of the fact that her urine still contained some pus. Tubercle bacilli 
were found on June i8th. 

Case jj, — Tubercular left kidney, ureter and bladder, nephro- 
ureterectomy. Death in forty-eight hours from sepsis. 

A. G., aged nineteen, single, father died of phthisis, general health 
is poor. Entered St. Michael's hospital, March 2d, 1903. Menstru- 
ation irregular, with some pain and scanty flow. She was hoarse and 
had been so for some months but no lesion of the vocal cords was 
discovered. For two years she has had pain in the left loin and 
since three months complains of much scalding on urinating, and 
sharp shooting pains in the bladder at all times. She makes the 
impression of a patient suffering greatly. An examination was ex- 
ceedingly painful, and she was, therefore, placed under ether for that 
purpose. There was a much thickened left ureter and tubercular 
ulcers were found in the lower posterior half of the bladder. On 
March 28th, the left kidney and ureter were removed down to the 
bladder. After the operation she vomited incessantly, her temperature 
rose rapidly and she died in less than forty-eight hours of acute sepsis. 

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FEMALE URINARY TRACT. 269 

DISCUSSION. 

Dr. Horace G. Norton, of Trenton.— The Society is certainly 
* to be congratulated on the presentation of such papers as this. 
Undoubtedly more attention should be given by the general practi- 
tioner to the diagnosis of tuberculous disease of the genito-urinary 
tract. I am very sorry indeed that Dr. Ill did not have time to enter 
into the matter of the diagnosis of these forms of disease. Operations 
on cases in which the disease is confined to one kidney are apparently 
very successful — sometimes a nephrectomy and sometimes a nephrot- 
omy. Ordinarily more cases of tuberculous disease of the urinary 
tract occur in the male. I understand that the author does not think 
the kidney is likely to become infected through the bladder, or that 
the disease proceeds upward from the bladder through the ureter. 
This is a mooted question, but I believe the kidney and bladder may 
be infected both by an ascending and a descending degeneration. I 
have seen some cases of tuberculosis of the bladder that so closely 
simulated stone in the bladder that a good deal of unnecessary and 
harmful sounding of the bladder has been done. 

Dr. III. — I did not mean to say that the kidney is not a£fected 
through the blood current, but that the bladder exhibited great resist- 
ance to tuberculous disease, and that the bladder is less liable to 
infection from the blood current. 

Dr. Philip Marvel, of Atlantic City. — I should like to ask Dr. 
Ill with reference to the bacilli. The author stated that it was difficult 
at times to find the tubercle bacilli, but he did not mention in his 
paper the danger of mistaking other bacilli, and especially the 
smegma bacillus, for the tubercle bacillus. I should like to know if 
there is any better means of differentiating between the two than 
washing out the preparation with pure alcohol. There is such a great 
similarity between the two bacilli that it is with difficulty that the 
ordinary observer is able to differentiate them. We have employed 
the method I mention, and so far it has apparently yielded trustworthy 
results. Of course the catheter is another means used. 

Dr. III. — One method is to wash out the coloring matter from the 
bacilli with alcohol. Another method is to very carefully catheterize 
the patient, in order to obtain a specimen for examination, and never 
to make use of urine that has been passed by the natural channels 
for such an examination. If the catheterization is carried out with 
aseptic precautions the smegma and other bacilli should not be 
present. 



270 MEDICAL SOCIETY OF NEW JERSEY. 

Two Unique Malformations of the Female 

Generative Organs; Absent Vagina With 

Atresia Uteri; Uterus Didelphis 

With Left Hematometra. 

BY EMERY MARVEL, M. D.. ATLANTIC CITY, N. J. 

While many types of malformations of the female generative 
organs are not uncommon, the two cases which I wish to report — 
(i) An absent vagina with atresia of uterus ; (2) Uterus didelphis with 
left herhatometra — seem each sufficiently unique in itself to merit 
record. When we consider the development of these organs through 
the fusion of the Mllllerian ducts, the two canals coming together 
to form one canal, and this common canal segmenting to form the 
respective organs, it is surprising that malformations of these organs 
are not more commonly met. The failure of the Mftllerian ducts to 
unite, results in one of two conditions, either further development is 
made, with duplication of that organ, or atrophy takes place leaving 
only a rudiment or no prestige of the organ at ail. If a given 
segment does not coalesce, but continues to grow, two separate 
canals develop. Such a condition is normal in the upper segment 
which forms two fallopian tubes. When, however, the first of the 
lower segments fails to unite and further development takes place, 
some form of a double uterus, such as uterus bisepta, uterus bifida, 
uterus bicornis, or as in the case here to be reported, uterus didelphis 
results. Should atrophy take place, an atresia of the segment, or its 
obliteration, as in the absent vagina, is the consequence. When, 
however, defective formation takes place, an impaired or disturbed 
function is consequent and sooner or latter a marked pathological 
condition results. Such was the manifestation in the following cases: 

ABSENT VAGINA WITH UTERINE ATRESIA. (Figure I.) 

In February, 1901, a patient called at my office, saying that he and 
his wife wished me to arrange to remove his wife's ovaries. When 
asked the reason for this unusual request, he said that every 
month his wife suffered most severe pains for about five days, and 
that two days of this time, she was most like a mad woman with 
the agony. Upon further inquiry, he told me his wife had never 
had her sickness, and I learned that complete coitus had not been 



IWO UNIQUE MALFORMATIONS. 2/1 




FIG. I.— CONGENITAL ABSENCE OF VAGINA. 



2^2 MEDICAL SOCIETY OF NEW JERSEY. 

attained. I immediately thought of an imperforate hymen or atresia 
of the vagina. I arranged to see his wife the next day, and found a 
well-nourished and apparently, perfectly developed woman, with the 
following history : 

Age, 23; married 5 months; never menstruated ; at 17 she ex- 
perienced an attack of pains, which are described to have been a 
feeling of burning with fullness and bearing down in the lower 
abdomen. The pains continued for five days and disappeared to 
return again every twenty-eight days for three consecutive months. 
Subsequent to this time, six months passed without recurrences, 
when the pains again returned and have since regularly recurred every 
twenty-eight days. These painful periods have progressively grown 
worse. For the past year she has been obliged to remain in bed 
each time. More recently they have been so severe, that her husband 
claims she is delirious for a part of the time. Morphine is reported 
to have been the only treatment that has given any relief whatever, 
and it has been necessary to frequently repeat it each period to secure 
any benefit. 

Gynecological examination : The labiae majoras are well developed ; 
clitoris fully formed and free from adhesions, urethral meatus in nor- 
mal position and condition. The labial minorae are normal to external 
appearances, when separated, however, they are found more intimately 
approximated than is usual. The inner surfaces are continuous one 
with the other, giving the appearance of an imperforate hymen. 
There being no entrance to the vagina, the rectum is utilized for a 
digital examination. The rectum is free, and for a distance nearly the 
length of the examining finger, no intervening resistance could be 
felt between the finger in the rectum and the palpating hand above 
the symphysis pubes except the bladder. The tip of the examining 
finger in the rectum impinges upon a resisting mass which can be 
felt by the opposing hand, but not definitely circumscribed. This 
mass is taken to be either the uterus or retained menses in an atresed 
vagina. Both ovaries are palpable and enlarged. 

Operation, March loth, 1901 : — The abdomen was opened to deter- 
mine more clearly the condition of the uterus and ovaries. The mass 
felt by the finger in the rectum proved to be the uterus of full normal 
size. The tubes seemed normal in appearance, although no attempt 
was made to determine positively the patulosity of their lumen. 
Both ovaries were enlarged by several small cysts. Each was de- 



TWO UNIQUE MALFORMATIONS. 273 

livered and all the cysts incised. The cavities were cauterized with 
therm o-cautery> and the ovaries replaced. The abdominal wound 
was closed and an effort made to establish an open way from the 
cavity of the uterus to the vulva. In the lithotomy position the space 
between the labiae was incised and a dissection was made through the 
interstitial tissue of the vesico-rectal space. The cervix was found, 
and with difficulty entrance made through it to what was supposed to 
be the uterine cavity. Flaps were formed from the scant surface of 
the labias minors and reflected into the made vaginal space, and the 
cervix uteri brought down and anchored with cat -gut sutures. Two 
weeks later, the anchoring stitches were torn out. The uterus had 
receded and the new vagina was closing. A second attempt to 
establish a vaginia was made. This time the same dissection was 
repeated ; a glass tube long enough to reach from the cervix to the 
vulva was inserted through the cervix into what was supposed to be 
the uterine cavity. This tube was anchored with silver wire, and the 
patient left the bed in a week. For two months subsequent to this 
operation she had no pains, although the tube came away in four 
weeks. The third month the same pains recurred in mild form and 
continued to recur each month subsequently. Each period grew 
more severe until I was appealed to again by her husband to try no 
further experiments but to remove the cause. I had observed these 
periods of pain several times and they were most severe. More 
severe than any dysmenorrhoea I had ever seen. On September 17th, 
1902, the abdomen was again opened and the uterus, tubes and 
ovaries removed en masse. The left ovary was as large as a hen's 
egg and the right ovary fully the size of a goose's egg and surrounded 
with generous adhesions. The enlargements were due to cysts, 
many of which ruptured in breaking up the adhesions. The uterus 
seemed much larger than when inspected fifteen months previous and 
was unusually hard. When a longitudinal section was made, the 
cervix was found to be fibroid and having no canal. The fundas 
contained a small slit, about half an inch in length, which was the 
only cavity in the uterus, and undoubtedly was never entered by any 
attempt made from below. Peritoneum was brought over all the raw 
surfaces of the broad ligaments, and the abdomen closed with cat- 
gut tiers. An uneventful recovery from this operation was made, 
the patient leaving the hospital in two weeks. When seen June 8th, 
two weeks ago, she reports herself free from pain, and absolutely 
well except for some annoyances occasioned by hot flushes. 

18 



274 



MEDICAL SOCIETY OF NEW JERSEY. 



UTERUS DUPLEX— LEFT-SIDED HEMATOMETRA. (Fig. 2.) 

A nervous but well-nourished white woman, twenty-four years of 
age, referred by Dr. E. H. Harvey, of Atlantic City. Married two 
years, no children, no miscarriages. Menstruated first at seventeen. 
Menstruation was very free and without pain, although preceded 




FIG. a.— UTERUS DIDBLPHIS, WITH HBMATOMBTKIA OF LEFT UTERUS. 



at intervals during the previous two months with headache and 
bearing-down, left inguinal pains. Did not menstruate again for 
three months, when menses returned, and during subsequent four 
years they were regular every thirty-two days, lasting five days. 
During this time there were no menstrual cramps, but frequently she 



TWO UNIQUE MALFORMATIONS. 275 

had a sense of fullness and bearing down in left ovarian region. For 
the past two years these discomforts have increased in frequency and 
severity, and have gradually grown so bad at menstrual periods as to 
necessitate her remaining in bed the first and second days. Eighteen 
months ago she noticed an intermittent, bloody, vaginal discharge, 
possessing an offensive odor. The discharge gradually increased in 
amount and constancy until during the last six months there has been 
a continuous show, becoming excessive at the menstrual period. The 
headache, together with backache, and those symptoms referrable to 
the lower zone of the left abdomen have grown worse with the in- 
creasing metorrhagia. With the conditions growing more severe, a 
chain of nervous symptoms, sleeplessness and hysterical manifesta- 
tions have come on. The odor of the discharge has been so foul as 
to make her presence objectionable to those around her and life 
almost a distaste to herself. The odor is much like the putrid dis- 
charge from a puerperal patient, being even more fetid. 

Gynecological examination : — Vulva shows a foul smelling bloody 
discharge, otherwise normal. The vagina normal except for a bulg- 
ing area to the left and anterior to the <ervix. The cervix high 
in vagina, and found posterior to the right, otherwise apparently 
normal. Above the cervix and to the left is a bulging in the vagino- 
uterine fornix. This mass fluctuates and cannot be separated from 
the cervix. In the medium line and inclined to the left is felt the 
uterus slightly larger than normal. The tube and a cystic ovary can 
be made out distinctly on the left. The tube cannot be detected 
coming from the right cornu, which seems rounded and not angular. 
In the right side is felt a tubular body, freely movable, with smooth 
surfaces and apparently attached to the body of the uterus near the 
cervix. The right ovary can be detected somewhat enlarged in 
about its normal position. 

Operation September 9, 1902. In the lithotomy position the vagina 
was exposed. The cervix uteri brought down to the vulva with tena- 
cula forceps. With a bistoury the mass to the left of the cervix was 
incised. From this incision about a teacupful of gelatinous, bloody 
fluid escaped. This escaped slowly and possessed the odor of decom- 
posed blood. The cavity was irrigated, and by a small, dull uterine 
curette explored and evacuated. The cavity was- continuous with the 
cavity of the uterus, but I was unable to find any connection between 
this cavity and the cervical canal, although I am convinced one 



276 MEDICAL SOCIETY OF NEW JERSEY. 

existed. Through a media abdominal incision the pelvic viscera 
were inspected. The body taken to be the uterus and emptied by 
vaginal incision is found to have but one tube and ovary attached. 
The smaller body apparently attached to the cervix is another uterus 
of diminutive size, and having one tube and ovary vsrhich comes off of 
the right side. The left ovary attached to the larger body is the size 
of a goose egg. adherent, and contained several cysts. Its corres- 
ponding tube was larger than normal, but free from adhesions. The 
right ovary, attached to the lesser uterus, is the size of a hen's egg — 
free, and contains several small cysts. The right tube is short and 
smaller than normal. The cervices of the two uteri seemed to unite 
at the peritoneal juncture to form one cervix. Just below this location 
both uteri were amputated, and with their respective ovary and tube 
removed. While the external surfaces of the cervices were united 
into one, the point at which the amputation was made had two dis- 
tinct canals, one continuous with the cervical canal into the vagina, 
the other continuous into the incision. 

The recovery was uninterrupted except for a stitch abscess. She 
reports May 1st, 1903, that she feels perfectly well with the exception 
of the hot flushes which occasionally annoy her. 

Congenital absence of the vagina may be due either to an oblitera- 
tion of a segment of the Mdllerian ducts, or to an imperfect division 
of the cloaca. Defective formation of the MQllerian ducts, failing to 
provide a vagina, is likely to have rudimentary uterus and ovaries. 
In the case here reported, these organs had attained their full size. 
The reverse condition is reported by Antonio Bustello-Livola^ He 
observed the absence of the uterus, tubes and ovaries with a fully 
developed vagina in a prostitute. 

The periodic pains having the cyclic time of menstruation must have 
been ovadan and due to ovulation. Both ovaries had undergone hyper- 
trophic changes and cystic degeneration. There was no evidence of 
true or vicarious menstruation, but the presence of an apparently 
functionally normal uterus and ovaries encouraged me to hope to suc- 
ceed in bringing about normal menstruation and establish a vagina. 
Emmett advised this efiFort'. Thomas' advised efforts to be made to 
establish a vagina {a) when there was retained menstrual fluid ; (^) 
a uterus can be distinctly discovered and the patient suffering from 
absence of menstruation ; (c) if the necessity for sexual intercourse 
be imperative. 



TWO UNIQUE MALFORMATIONS. 277 

Had I known of the uterine atresia I could not have hoped for a 
favorable result, but there was no way by which I could well deter- 
mine that. After puncture of the cervix, in which there was no canaU 
the sound entered the uterine tissue with comparative ease, so much 
so that I mistook it for the uterine cavity. After inspecting the uterus 
through a section of its body, and studying the course of the patient, I 
am fully convinced that the remedy for her relief rested in the removal 
of the ovaries, and the fibroid change in the uterus is of itself suffi- 
cient, I feel, to justify its removal. 

Dr. John G. Clark ^ reports a case of bicornate uterus, one horn of 
which was filled with pus and having a downward saculation, which 
pressed upon the lateral wall of the vagina. Dr. Clark's case and 
that of my own have very analogous conditions with this difference — 
that in his case the retained menses had become infected. A strange 
coincidence in these two cases is that, rare as it is, both cases seen 
were referred by Dr Harvey. The first case Dr. Harvey saw at 
Latimer. Pa., and referred to Dr. Clark, January, 1901. The other 
case he first observed a little more than a year later. The case which 
was operated on by Dr. Clark and reported by him, the infected 
cornu was amputated and removed, leaving the normal cornu. Dr. 
Harvey tells me that he has just heard from this patient, and that she 
has given birth to one well-developed child and has since miscarried 
at three months. 

In my own case, although it was not demonstrated, the evidence 
favors the fact that there was some opening present between the 
uterine cavity distended with blood and the free cervical canal of the 
right uterine cavity, and that this opening was not sufficiently large 
to give free drainage. This was evident by the discharges through 
the vagina being of the same material as was the retained menses in 
the distended uterine cavity. 

The question of removing both of these uterine bodies, or only the 
distended one, was considered while the abdomen was opened, but in 
view of the fact of both ovaries being markedly cystic, it seemed 
advisable to me to take both out at this operation. 

I cannot conceive of any drugs, or any, but operative remedies, giving 

any benefit in either of these conditions, and I am fully convinced 

that radical operation was the only remedy in one case and to have 

been the preferred treatment in the other. 

I. Annals. Gyn. and Pediatry. No. 13, Vol. XV. 

3. Op. Git., p. 189. 

3. Op. Cit., p. 227. 

4. U. of P. Med. Bulletin, No. 3. Vol. XIV. 



278 MEDICAL SOCIETY OF NEW JERSEY. 

DISCUSSION. 

Dr. £. J. Ill, of Newark. — I think the author deserves much credit 
for bringing these interesting cases before us. I have seen the condi- 
tion described in the second case on three or four occasions. One of 
these patientSp a woman of sixty, had a foul discharge from the vagina. 
She had never been married. From the discharge I suspected malig- 
nant disease of the uterus. The examination puzzled me at first, 
since I could find no origin of the discharge, because my examination 
was conducted through the right vagina, while the carcinoma existed 
in the body of the left uterus. Besides this there was a large ovarian 
tumor coming from the right ovary. In other words, the case was 
one of two vaginae and two uteri, carcinoma of the corpus of the left 
uterus and an ovarian tumor of the right ovary. 

The case of hematometra of one-half of the uterus, I would have 
treated differently, as I did in two cases that came under my obser- 
vation. I opened the blood sack through the vagina and stitched the 
vaginal mucous membrane up into the uterine cavity. Both continued 
to menstruate normally. I once saw a case like the first one described . 
by the author, with the immense hypertrophy of the clitoris. The 
patient was a supervising nurse in a hospital, and another nurse came 
to me complaining that the supervising nurse was a woman of 
immoral character. She refused trial and left the hospital. Subse- 
quently she returned, and I found on examination a clitoris as large 
as the thumb and rudimentary vagina. There was an occasional 
bloody discharge. At first sight this individual appeared to be a man, 
and not a woman. I warned her not to nurse females. A year or 
two later I saw her for what was supposed to be an appendicitis, but 
I found it was not an appendicitis, but what appeared to be an ovarian 
tumor. An abdominal section showed a strangulated ovarian tumor. 
This woman told me that she had no desire for male company, but 
only female company, yet she had ovaries, /. e„ an ovarian tumor. 

Dr. Phillip Marvel.— I should like to ask the reader of the 
paper to explain the second diagram, because it is not clear to some 
of us. The tubes are exceedingly long in proportion to the normal. 

Dr. Emery Marvel. — The illustration does not give the natural 
size, it being entirely diagramatic. ' The proportion is probably 
about one to three. The proportion of the ovaries on each side to the 
respective uterus of that side is about proper. I would have been 
tempted to take out only one uterus if it had not been for the peculiar 



PRACTICAL METHODS OF HYDROTHERAPY. 279 

condition present in this case. Another operator adopted this plan, 
and the attending physician told me that he had heard that the 
woman became pregnant subsequently and gave birth to a child. I 
have not been able to confirm this report, but if this should be true 
I should feel it would be justifiable to attempt to save one uterus 
were the appendages not seriously affected. 



Some Practical Methods of Hydrotherapy for 
General Practice. 

BY ELIOT GORTON, M. D., FAIR OAKS SANATORIUM. SUMMIT, N. J. 

In presenting for the consideration of this Society some of the 
simple, though effective, measures of hydrotherapy, it is my aim to 
overcome in some degree the apathy and prejudice of the general 
practitioner toward a subject which merits a larger share of his 
attention. 

The progressive work of such men as Winternitz, in Vienna, and 
Baruch. in New York, has rescued hydrotherapy from the domain of 
quackery and placed it upon a sound physiologic and scientific basis 
beyond the realm of empiricism, and it is largely to these men and 
their pupils that we owe our present knowledge of the rational appli- 
cation of water to diseased conditions. Correct technique is 
absolutely essential to good results, and it is the absence of 
technique — the inattention to the necessary details — which is re- 
sponsible for the lack of confidence in and the feeling of indifference 
toward hydrotherapy, so prevalent among the profession. 

In this era of progressive medicine it is astonishing that the skin, 
the largest and most accessible organ of the body, should be so 
much neglected in therapeutics. Ramified by miles of capillaries and 
arterioles, the calibre and tone of which are readily influenced ; with 
millions of minute excretory organs, the efficiency and activity of 
which are easily affected ; with myriads of nerve endings directly 
accessible, we have in the skin an organ through which we are 
enabled to directly and powerfully influence the blood and lymph 
vessels, the excretory and the nervous systems. The flexibility and 
range of hydrotherapy are so great that good results may be 
obtained from the simpler procedures which require no complicated 
apparatus. In the various forms of baths, the effect desired must not 



28o MEDICAL SOCIETY OF NEW JERSEY. 

be lost sight of. It is just as necessary in hydrotherapy to individual- 
ize the patient as in other medical measures, and our use of any 
prescribed form of bath must be governed as much by the condition 
of our patient as the effect desired. 

In hydrotherapy we are using four agents— moisture, temperature, 
friction and mechanical force, and it is the manner of using and 
combining these elements which constitutes its entire art. The 
better and more elaborate the apparatus, the more exact, of course, 
can we make our prescription in a given case, but the point I wish to 
emphasize is that with simple fixtures and with no special apparatus 
at all, a great deal of satisfactory work can be accomplished. The 
only absolute essentials are water and a bath tub. Witli these, a 
bath thermometer and proper technique, good results can be 
obtained. 

It seems to be an accepted conclusion among most medical men 
that the chief aim of the cold bath is to reduce temperature and 
should only be used, if at all, in cases of fever, and that all baths 
have for their object the modification of temperature. Many, for 
instance, think the sole object of the Brand bath in typhoid is to 
lower the temperature, when, as a matter of fact, the chief and 
important effect is its soothing and calmative effect upon the nervous 
system. Baruch says : " Temperature reduction is perhaps the least 
potent factor in the therapeutic effects to be expected from the appli- 
cation of water," and " the long prevalent idea that in its capacity of 
reducing temperature lies the chief strength of hydrotherapy, is 
fallacious." 

The limited time at my disposal prohibits the presentation of clini- 
cal data in support of statements to be made, but I propose to direct 
your attention to a few practical, yet simple, hydrotherapeutic 
measures, and to point out some of the conditions where they are 
a most valuable adjunct to other forms of treatment. Let us con- 
sider first the technique and therapeutic purpose of the so-called 
warm full bath. In this bath the entire body, except the head, is 
covered with water. The tub is filled three-quarters full at a 
temperature of 98^ to 102® and should be kept at that temperature. 
The head should first be bathed with cold water and wrapped in a 
towel wrung out of cold water. Preparatory to all hydrotherapeutic 
measures the head should first be wet with cold water and encircled 
with a cold, moist towel. This is an important point in the technique 



PRACTICAL METHODS OF HYDROTHERAPY. 28 1 

which is often overlooked. The patient lies in the bath without 
effort, and is left undisturbed for fifteen minutes : or, in some cases, 
gentle friction over the body by an attendant may be employed. 
This bath has a marked sedative action, and is very useful in cases of 
insomnia and delirium, for reducing temperature, for relieving pain 
and to quiet nervous irritability. When used for insomnia, delirium, 
or temperature reduction, friction when in the water and active towel 
rubbing after emerging from the tub. should be omitted. The 
capillaries are dilated and the internal blood pressure is much 
reduced. Respirations become slower and are at first shallow, but 
later are full except the bath be too prolonged. The pulse is first 
slowed and then increased in frequency. When prolonged, and it 
should be of at least twenty minutes duration in insomnia, the 
temperature rises but returns to normal in half an hour. On leaving 
the bath the perspiration should be abundant, and herein lies one of 
its chief virtues in the treatment of kidney diseases. Should palpita- 
tion of the heart or a sense of great heat occur, it should be stopped. 
Baelz, of Tokio, has demonstrated that the former teaching that colds 
are easily contracted after the hot bath, is erroneous, for the reason 
that the paralysis of the cutaneous vessels lasts some time and 
prevents their contraction when exposed to cold. In patients suffer- 
ing from heart disease, the temperature of this bath should never 
exceed 95**. 

The half 'bath, — The half-bath is by far the most important of the 
more simple measures, because of its great range for modification to 
meet existing conditions and its ease of administration. It contains 
all the elements of hydrotherapy— moisture, temperature, friction and 
force. The technique is as follows : 

The head is first wrapped in a towel wet with cold water, a warm 
drink is given, and the patient, after complete immersion, sits forward 
in the tub, which is less than half full of water at a temperature of 
90''. With a two-quart dipper the attendant throws water dipped 
from the tub, with some force, against the back and upper extremities, 
and at the same time the patient rubs his abdomen and chest. This 
procedure is maintained for one and one-half minutes. The patient 
then sits back in the tub and the water is thrown against his chest for 
the same length of time. The attendant then rubs the back, chest, 
arms and legs briskly for about one minute. The temperature of the 
water is then reduced from three to five degrees and the water throwing 



282 MEDICAL SOCIETY OF NEW JERSEY. 

process repeated, after which the patient is rubbed dry. As he becomes 
accustomed to repeated baths, the water at the start may be slightly 
reduced in temperature from day to day, and a difference in tempera- 
ture of 5^ maintained between the two stages, but the water should 
never be reduced below 68^. If in doubt as to the proper tempera- 
ture with which to begin, it is a safe rule that the bath may be started 
with water lo*' to 12° below the body temperature of the patient. Its 
average duration is six minutes. 

The effect of the half-bath depends upon the way it is administered. 
The first effect, however, is stimulative, from the splashing, and the 
subsequent reaction is brought about by the rubbing and the splash- 
ing with colder water. Cold baths of short duration with brisk 
rubbing give greater stimulation, while warmer baths with longer 
duration have a sedative action. In diseases of the central nervous 
system, it must be given warmer with a range of temperature from 90" 
to 80°. It is then a valuable agent for the relief of the lancinating 
pains of tabes dorsalis. In the aged, the first temperature of the bath 
must be about 95^. In tuberculosis its effect is most marked. Its 
daily use, six minutes in duration, beginning at 85^ and ending with 
water at a temperature of 80^, lessens the distressing cough, improves 
respiration and the vascular tone, increases the appetite and retards 
general wasting. Another disease in which this bath is indispensable 
is epilepsy. You are familiar with cases of this disease in which the 
prolonged administration of bromides has produced an unsightly and 
disagreeable acne, necessitating their discontinuance. In this condi- 
tion, the rapidity with which the skin clears up and the breath becomes 
sweet is remarkable, and a greater tolerance is also established for the 
bi'omides. The bath is quite as important where bromides are admin- 
istered for any length of time as the bromides themselves. In 
neurasthenia and hysterical conditions it may also be used with great 
benefit, for the tonic effect upon the nervous system. In chronic 
gastro-intestinal complications, particularly cases of chronic gastritis 
and enteritis, this bath, followed by the pouring of water upon the 
abdomen from a pail held at a height of four feet and repeated three 
to six times, often effects marked improvement. This is the *' thermic 
massage " of Wintemitz. 

The half-bath can be used with or without the hot-air cabinet, but 
when the latter is used it must precede the bath. All patients will 
shiver when first entering the tub, but this ceases in a few minutes 



PRACTICAL METHODS OF HYDROTHERAPY. 283 

when reaction begins. When properly administered, the skin is red- 
dened and the after effect is a pleasurable one of warmth and well- 
being. The effect of the half-bath is that of a general tonic. It is a 
stimulative, refreshing measure, and is only contraindicated by chill, 
a state of collapse, or any condition of extreme weakness where the 
giving of any bath would be hazardous. 

Wet packs, — The wet packs, hot and cold, are other simple measures 
of great value. These must also be given with rigid adherence to 
technique, else they are of no value. The unfavorable results so often 
obtained from their use in private practice are often chargeable to the 
lack of knowledge of the proper technique on the part of the nurse. 

The cold pack is the one most in vogue, and is used in fevers for its 
antipyretic effect, and is especially valuable in cases with high pulse 
rate. In diphtheria and angina the renewed cold pack, according to 
Winternitz, is almost a specific, and in functional motor neuroses, 
chorea, athetosis, neuralgia, goiter, palpitation of the heart, kidney 
disease and diabetes— in fact, in any condition where a marked dia- 
phoretic action is desired, it is invaluable. As a sleep producing 
agent it has no equal, and distressing cases of insomnia, where the 
ordinary hypnotics have been of no avail, are often relieved absolutely 
by the cold pack. In cases of extreme weakness and in heart disease 
it is usually contraindicated, and if used must be given with great 
caution. In maniacal conditions and in states of delirium the sedative 
effect of a prolonged cold pack is very marked, and these patients 
often go to sleep while in the pack. The motor restlessness is greatly 
relieved, the patients become quiet and sleep is soon induced. In 
nephritis the hot pack is preferable. In neurasthenia, hysteria and all 
functional neuroses, the cold pack is highly commended. The tem- 
perature of the cold pack is from 70° to 60** and the hot pack 100°. 
They are given in the following manner : 

Three woolen blankets are placed upon the bed. A coarse linen 
sheet wrung out of water at the desired temperature is placed over 
the blankets. The head is wet and encircled with a cold compress. 
The patient then assumes the recumbent position upon the sheet with 
the arms over the head. One edge of the sheet is placed at the side 
in line with the axilla, and the sheet is then brought around to the 
front of the body. The arms are then placed at the sides, and the 
sheet is carried around so as to envelop the arms and shoulders. It 
is then pressed between the limbs, and in this way every part of the 



284 MEDICAL SOCIETY OF NEW JERSEY. 

body is covered and no two points of skin are in contact. The sheet 
must come closely around the neck above the shoulders and the feet 
must also be well wrapped, each one separately. It is very important 
that the sheet comes into contact with every part of the body, and 
that no two skin surfaces are in apposition. The blankets are then 
wrapped around the sheet in the same manner and brought snugly 
around the neck. It is absolutely essential that all air be excluded, 
and if the blankets do not come snugly around the neck the patient 
will experience much discomfort. When properly applied there is no 
discomfort after the first shiver from the cold sheet. The duration of 
this pack should never be less than one-half hour and from that to 
two hours or longer, depending upon the effect desired. During the 
pack, drinking water should be given freely, and while in the pack the 
patient should never be left alone. When practicable, it is customary 
to follow all packs with the cold rain bath of five seconds duration, 
and this again by brisk rubbing. 

Let me recapitulate the salient points in the technique of the pack : 
I. Head wrapped in a towel wrung out of cold water. 2. Sheet 
wrapped so that no two skin surfaces are in contact. 3. Blankets 
wrapped closely around neck so that all air ingress is absolutely 
excluded. 4. Drinking water to be given freely. 5. Duration not 
less than one-half hour. 6. Constant attendance. 

Drip 5^^//.— Another simple measure largely used for its tonic 
effect is the drip sheet. This is usually given on rising in the morning, 
and its technique differs from that of the cold rub only in that the 
sheet is not wrung out. It is taken dripping from the water at a 
temperature of 70^, and wrapped around the patient in the same manner 
as in the pack, the patient standing and the attendant applying rapid 
friction over all parts of the body through the sheet, until the patient 
is thoroughly warm. During the rubbing process a pitcher of water lo** 
cooler may be poured over the head and shoulders. The drip sheet 
is useful in neurasthenia, states of depression and nervous conditions 
generally, where a stimulating and tonic effect is desired. 

The baths and packs used in the treatment of typhoid need no 
comment. That hydrotherapy has been one of the chief agents in the 
reduction of the mortality from this disease is now generally con- 
ceded. However, during the past few years, there has been a gradual 
extension of the field of hydrotherapy to allied conditions, and this 
agent is now recognized, especially on the continent of Europe, as an 



TRANSITORY COMPLETE BLINDNESS. 285 

adjunct of the first rank in the treatment of the acute gastro-intes- 
tinal conditions of infancy and childhood. This is especially true of 
the more severe conditions accompanied by high temperature and 
marked diarrhoea, with frequent watery discharges. In these cases, 
the administration of the cold pack two or three times daily, if neces- 
sary, depending upon the temperature of the patient, is very 
efficacious. In fact, in the estimation of some, the routine treatment 
of these cases after this manner, deserves the same consideration that 
similar procedures command in typhoid. It is certain that this is a 
valuable adjunct to other modes of treatment in allaying the irrit- 
ability, reducing the temperature and lessening the discharges of the 
violent summer diarrhceas of children. The technique is the same 
as for adults except that the duration of the pack should be from 
fifteen to twenty minutes. The use of this form of bath treatment in 
the pneumonias of childhood has many warm advocates abroad, 
but has received only little support here. I have had no experience 
with it, but the high authorities who actively advocate its use in 
these conditions, make it worthy of our serious attention. 



Two Cases of Transitory Complete Blindness of 
Both Eyes. 

' I. Case : Idiopathic Optic Neuritis. 
II. Case: Amaurosis, probably from Autointoxication. 

BV CHARLES J. KIPP, M. D., NEWARK, N. J. 

Case I,— Idiopathic Optic Neuritis — Mrs. K. S., aged thirty-two ; 
has been married eleven years and is apparently in robust health. 
She has given birth to two children, both of whom are living and in 
good health ; the younger is four years old. Patient has always been 
in good health. No history of syphilis. For some weeks she has 
suffered more or less from frontal headache. She came to the 
Newark Eye and Ear Infirmary for the first time December 22d, 1891, 
complaining of loss of vision of left eye and impairment of vision of 
right eye. The examination made at this time showed that the 
exterior parts of the eye were perfectly normal in appearance, and 
that the movement of the eyes were unimpeded in any direction. On 
closer examination it was found that the left eye was blind ; this eye 



286 MEDICAL SOCIETY OF NEW JERSEY. 

could not distinguish between light and darkness. The pupil of this 
eye was larger than that of the right eye and it did not react to 
light. It did, however, respond to light thrown in the right eye. 
The ophthalmoscope showed clear media and a well marked papillitis. 
The optic disc was swollen and apparently enlarged. The retinal 
veins were full and tortous, while the arteries were of about normal 
calibre. The retina immediately surrounding the disc was hazy but 
otherwise it was normal. The right eye also showed swelling and 
enlargement of the optic disc, but not quite so marked as that of the 
other eye. The retina was transparent except very close to the optic 
disc. The pupil of the right eye was of normal size and responded 
readily to light. The sight of this eye was reduced to ^, An exam- 
ination of the urine showed it to be free from albumin and sugar. 
Close questioning failed to reveal disease in any other part of the 
body. She was given iodide of potassium in small doses. She was 
seen again the next day, when It was found that both eyes were now 
totally blind. She could not recognize the light of a candle held 
close to her eyes. The swelling of the optic discs had increased. 
Their surfaces were best seen with a 3 dioptric glass. The pupil of 
the right eye was now as large as that of the left eye, and neither 
pupil reacted to light. She remained in this condition up to December 
28th, when she could distinguish between light and darkness. 
December 30 it was found that the pupil of the right eye responded 
very sluggishly to light but contracted in convergence. The pupil of 
the left eye responded even more sluggishly than the right eye to 
light, but also contracted in convergence. She can see movements of 
hands in front of her eyes, but cannot yet count fingers close to her 
eyes. She was at this time taking fifteen grains of iodide of potas- 
sium three times daily. On January 8th, 1892, it was found that the 
pupils of both eyes reacted to light in convergence fairly well. The 
vision of both eyes remained about the same as at last January 14. 
Can now count fingers with either eye at four or five feet. Has still 
frontal headache. The optic discs are less swollen and the retina 
adjoining the disc is more transparent. 

January 22. Her vision is now in the right eye f^^ in the left A- 
The visual field is intact in both eyes. Is taking twenty grains of the 
iodide three times daily. After this time her vision gradually improved 
so that on February 5th it was in either eye \, The discs were now 
almost flat and quite white. The headache had subsided. 



TRANSITORY COMPLETE BLINDNESS. 287 

On March 1 5th her vision was about normal in both eyes, and the 
visual field intact in both. During the following five years I saw the 
patient at intervals of several months, and always found her in good 
health. Her vision when I last examined her, five years after the 
attack, was normal in both eyes, and so were the visual fields. Her 
health was excellent. I have been trying to find her since, but have not 
succeeded in so doing. 

The absence of the pupillary light reflex for a while made it prob- 
able that the seat of the lesion was in the visual tract, this side of the 
corpora quadrigemina. 

The visual centres may also have been involved, but this cannot be 
proved, as the conduction of visual impressions was interrupted by 
disease of the tract. The ophthalmoscope showed the existence of a 
marked optic neuritis in both eyes. Cases in which an optic neuritis 
has caused total blindness of both eyes, and in which the pupillary 
light reflex was absent for a time, with subsequent restoration of 
normal vision are exceedingly seldom met with. With the exception 
of a frontal headache, my patient was in excellent health at the time 
the optic neuritis developed, and, as she remained in good health dur- 
ing the next five years, it seems reasonable to assume that the eye 
disease was not the result of a general affection, which was latent 
when she became blind. 

Case 2, — Amaurosis, probably from Autointoxication— ^ixs, S.. 
aged thirty-two, stout, of typical bilious temperament, is subject to 
frequent attacks of headache; is constipated most of the time; is 
fond of rich food and indulges freely in eating. 

On July 27th, in the evening, was attacked with a sudden intense 
pain in the head with nausea and vomiting. The attack was so 
severe that her attending physician was obliged to give her one- 
quarter grain of morphine hypodermically. She was relieved in about 
half an hour. Calomel and Warburg's tincture were given ncAct morn- 
ing, but did not act well. In the evening of this day, at about the 
same hour as on the previous day, another severe attack of headache 
came on and another dose of morphine was given her, which gave 
her some relief. 

On the morning of the 29th she was given one ounce of Warburg's 
tincture, and in the evening she received ten grains of quinine. She 
had no attack of headache on this day. 

On the 30th, in the evening, she had another very Severe attack of 



288 MEDICAL SOCIETY OF NEW JERSEY. 

headache. In the morning of this day she had taken ten grains of 
quinine and ten more in the evening. During the night of the 30th 
she noticed that her vision was becoming impaired, and on the morn- 
ing of the 31st she was totally blind in both eyes. Pupils reacted 
but feebly to light. I saw her for the first time shortly after noon on 
this day. She acted like a person who was absolutely blind and was 
quite self-possessed. I found that the movements of the eyeballs 
were unimpeded in any direction. She was unable to recognize the 
position of a lighted candle held but a short distance from her eyes. 
The pupils of both eyes responded readily to light and in convergence. 
The ophthalmoscope showed absolutely normal eye grounds. In 
one of her eyes she had a patch, of opaque nerve fibres such as is 
frequently seen in eyes with good vision. There was absolutely 
nothing hysterical about the woman. I feel very confident that she 
did not exaggerate her impairment of vision. The hearing was 
normal. I made a favorable prognosis. An examination of her 
urine showed it to have a specific gravity of i^ojo; it contained a 
trace of sugar but no alkumin. The quantity of urine passed during 
the day preceding the blindness is not accurately known» but it was 
said to have been of the usual amount. The bowels had not moved 
freely for some days, although sulphate of magnesia in large doses 
had been administered at frequent intervals. A high enema was 
given shortly after I saw her. which brought away a quantity of fecal 
matter, in which, on examination, were found seeds of berries eaten 
two weeks before. The total blindness continued for thirty-six 
hours, and then gradually her vision returned in both eyes. There 
was no rise in temperature during the attack, but on the day following 
her temperature rose to 102. A week after the attack her vision was 
as good as before the attack, and the visual fields were of normal 
extent for white and colors in all directions. All our efforts to find a 
cause for*the sudden blindness were fruitless. She had no disease of 
the kidneys. Habitual constipation, for which she was always taking 
cathartic mineral waters, was about the only abnormal condition 
which we could discover at the time. She has been in her usual good 
health ever since. That this was a case of amaurosis from some kind 
of intoxication there can be no doubt. But as to whether it was due 
to a poison introduced into the body from without, or whether the 
poisoning was the result of an inadequate physiologic elimination of 
the product of the tissue metamorphosis, or of the formation of a 



TRANSITORY COMPLETE BLINDNESS. 289 

poison in the intestinal tract clue to abnormal processes of decom- 
position or fermentation must remain in doubt. That the poison was 
not introduced from without seems, however, pretty certain. Neither 
the food of which she had partaken nor the drugs which had been 
administered can be held responsible for the eye affection. We 
know that quinine will occasionally produce blindness even in com- 
paratively small doses, but both the clinical features and the absence 
of all change in the backgrounds of the eyes, as well as the subse- 
quent history of the case, show that this drug was not the cause of 
the blindness. The absence of disease of the kidneys probably elim- 
inates uraemia as the cause of the amaurosis, though it must be 
admitted that this attack closely resembles in all its features the 
blindness known to occur in this affection. In one of the examina- 
tions of the urine a trace of sugar was found, but only once, and none 
has been found since the attack. With the exception of habitual 
constipation, there is no evidence of the presence of a morbid 
affection of the digestive tract, and yet the most plausible explanation 
seems to me to be that the toxine which caused the amaurosis was 
formed through putrifactive changes of the contents of the intestinal 
tract. As to the part of the visual apparatus affected in this case, 
there can be no doubt. The blindness with prompt pupillary 
reaction to light established the fact that the optical centres were the 
seat of the lesion. But as to whether it was an oedema of the men- 
inges or an affection of the brain substance itself, no one can tell. 
There are very few cases on record similar to the one here described, 
and in most of these the absence of albumin in the urine was not 
positively excluded. I am indebted to Dr. Cladek, of Rahway, for 
notes of the previous history of the case. 

To recapitulate,-— In both of the cases above reported, the blind- 
ness was due to an affection of the nervous visual apparatus. In the 
first the seat was in the conducting apparatus, as was manifest from 
the fact that the pupillary light reflex was absent during a part of the 
time that the blindness existed. In the second the seat of the lesion 
must be looked for in the optic centres as the pupils reacted promptly 
to light when. total blindness was present. In both cases the vision 
was completely restored. It is doubtful that the treatment adopted 
had anything to do with the restoration of the sight in either case. 

DISCUSSION. 

Dr. Frank Fisher, of Philadelphia.— The presentation of such 

19 



290 MEDICAL SOCIETY OF NEW JERSEY. 

papers is of intense interest, both to the specialist and the general 
practitioner, as all must be interested in the causes of amaurosis. 
Transient amaurosis is probably due to affections of various tissues. 
There may be a diseased condition of the rods and cones of the 
retina, or of the conducting cords back to the optical centres of 
brain. It is very often impossible to decide the nature of the cause 
in a case of transient amaurosis. Aside from the cases of lead, 
alcohol, mercury, phosphorus and ergot poisoning, it is very difficult 
to determine with any. certainty the exact cause. In one of the 
cases referred to, one naturally thinks of the possibility of quinine 
poisoning as the cause. In cases of malarial blindness and neuritis, 
discussion has often arisen as to whether the malaria was the 
cause, or whether the neuritis was due to the administration of 
quinine. This matter is still in dispute, and it will probably be long 
unsettled. Another suggestion from the paper is the possibility of 
auto-infection, or of infection being the real cause of many of these 
conditions of amaurosis, temporary or permanent. Possibly there is 
an underlying dyscrasia or diathesis which has been partially stimu- 
lated by alcohol, tobacco or other means. If such is the case, we 
must largely modify our opinions regarding the blindness following 
alcoholism and tobacco toxaemia. Dr. Kipp has more strongly sug- 
gested to my mind, the possibility of both of the cases reported by 
htm being due to come form of toxic poisoning having stimulated a 
pre-existing diathesis or dyscrasia. 



Acute Inflammation of the Accessory Sinuses 
OF THE Nose. 

BY NORTON L. WILSON, M. D., ELIZABETH, N. J. 

Acute sinusitis has become so frequent of late years, and is so 
often followed by a chronic condition which necessitates an operation, 
that I have thought it might be interesting and possibly, of some 
value, to present to this Society, a brief paper upon the subject. 

A correct idea of the topographical anatomy of the sinuses can 
only be obtained by the study of both dry and wet sections. The most 
of the plates in our text books representing these sections, are a very 
poor representation of them as they really exist. The subject, in my 
opinion, is one of great importance to the general practitioner. To 



ACCESSORY SINUSES OF THE NOSE. 29I 

him the patient first applies for help. Indeed most of the cases which 
come to me for treatment, are of the sub-acute or chronic variety. 

If the acute cases had been properly treated from the first, there 
would have been a few cases only of chronic character for treatment. 

The cure of disease is of invaluable benefit to mankind, but its 
effective prevention is of far greater importance. We should, there- 
fore, seek to obtain a better understanding of those causes which 
produce the disease under consideration, if we would the more suc- 
cessfully prevent its occurrence. It is within the knowledge of all 
who have observed the course of acute sinus inflammation, that 
severe symptoms may, in many cases, be successfully met and a 
speedy cure effected, if there be a prompt recognition of the trouble 
and a treatment which will be immediately effective. In order to 
prevent the resultant troubles, we should know the various causes 
to which they owe their origin. These may be either predisposing 
or exciting. 

Dr. D. Bryson Delevan, in his paper read last year at Saratoga^ 
pointed out certain existing causes, which directly pre-dispose to the 
disease under consideration. " It may not be," he said, "so generally 
understood, that in many instances, certain causes exist which 
directly pre-dispose to sinus disease ; causes in the presence of which, 
exciting influences of comparatively little importance in a normal 
nose may assume dangerous proportions and become the occasion 
of serious results. 

Predisposing Causes, — " Anything which seriously hinders free 
drainage from the upper half of the nasal cavity, may act as a 
pre-disposing cause," such as deflection of the septum, catarrhal 
thickening of the tissues of the upper and middle part of the septum, 
hypertrophic conditions of the turbinate, and especially the middle 
turbinate, polypi, congestive conditions of the soft parts, and by 
that term, I n>ean an engorged and swollen condition of the mucous 
membrane, which is not an hypertrophy, the formation of masses of 
granulation or even the presence of inspisated mucus. Any one of 
these may be a contributing factor in the cause pre-disposing to the 
disease. Malformations of this region of the nose are by no means 
invariably associated with disease of the accessory sinuses. They 
do, however, predispose to congestive troubles in general, and these 
in turn render the sinuses more liable to disease. Cases of acute 
sinus disease without any apparent malformations have, however, 
come under my observation. 



292 MEDICAL SOCIETY OF NEW JERSEY. 

Exciting Causes. — Inflammation and suppuration in the accessory 
sinuses may arise in the course of certain affections, such as influenza, 
pneumonia, scarlet fever, measles, typhoid fever, diphtheria, small- 
pox, cerebro-spinal meningitis and erysipelas. 

In regard to the last named disease, the above named author makes 
this pertinent remark : " It is questionable whether erysipelas may 
not in many cases be due to pre-existing sinus disease. Numerous 
instances of recurrent facial erysipelas have been observed in which 
the erysipelatous attacks have been done away with by the treatment 
and cure of necrosing ethmoiditis and similar diseased conditions of 
the accessory sinuses. This was the condition that existed in a case 
coming under my observation. The patient had had several attacks 
af facial erysipelas, and a final cure was effected by curetting the 
anterior ethmoidal cells. 

The inflammation may reach the sinuses by direct extension from the 
nose, fauces and naso-pharynx. or the cavities may become involved 
through the blood stream in the course of a general systemic infec- 
tion. This latter mode of infection I believe to be much less frequent 
than by extension from the nasal cavities. 

Among the most frequent exciting causes are influenza and croup- 
ous pneumonia. On the occasion of a recent visit to the Massachu- 
setts Eye and Ear Infirmary in Boston, there came under my 
observation several cases of acute inflammation of the frontal sinuses 
which accompanied or followed la grippe, and I have found cases 
resulting from such causes in my own private practice. I believe that 
to (his form of epidemic influenza may be attributed the increase in 
the number of cases of late years. Weichelbaum, during the epidemic 
of 1890 found suppuration present in a large number of post-mortem 
examinations upon influenza patients. 

Sinus inflammation may result from acute coryza without influenza 
infection. Suppuration of the sinuses has been ascribed to the pres- 
ence of polypi, but I am inclined to think that in most instances the 
polypi are due to suppurating sinuses — that is to say, the mucous 
membrane becomes irritated from the constant flow of pus over its 
surface, and a polypus springs therefrom. Grenwold and others have 
said that sinusitis is probably the cause of ozcena or atrophic rhinitis. 
This theory I can not accept, for the reason just stated, namely, the 
presence of pus causes an hypertrophy rather than an atrophy. I am 
rather inclined to believe the sinus disease is secondary to the atrophic 



ACCESSORY SINUSES OF THE NOSE. 293 

rhinitis. We are all familiar with catarrhal and suppurative processes 
in the middle ear as secondary to atrophic rhinitis, and I fail to recall 
a single case where the atrophic rhinitis was due to a suppurating 
ear. Certain it is that in all the acute infections of the sinuses wc 
have an inflammatory condition in the nasal mucous membrane which, 
if properly treated, gives prompt relief to the existing sinus disease. 
Dental caries, or operations upon the nasal cavities, or the use of 
instruments not properly aseptic, or the plugging of the nasal cavities 
for epistaxis, have caused disease of the antrum. Another prolific 
cause is to be found in the irritation from dust laden with bacteria. 
This is no doubt the reason for so many automobilists having diseases 
of the frontal and ethmoidal cells. 

Bacteriology, — To E. Frankel and Wichelbaum we are mainly 
indebted for the bacteriology of the accessory sinuses. They have 
found the diplococcus pneumonia, the bacterium coli and a number 
of pyogenic organisms. The influenza bacillus has been demonstrated 
by Lindenthal, Howard, Ingalls and Morizkowskie. True diphtheritic 
membrane has been found in the antrum by Weichelbaum, Frankel, 
Pearce and others. 

Pathology, — In accute inflammations the mucosa becomes congested, 
infiltrated with round cells and swollen, while a serous exudation 
is poured out, constituting an acute catarrh of the membrane. The 
exudation may become sero-purulent or purulent, and if mixed with a 
quantity of mucus it presents a muco-purulent character. If the 
ostium of the sinus becomes blocked by the swollen mucous mem- 
brane, the exudation is retained under pressure and the clinical symp- 
toms and signs become aggravated. 

Diagnosis. — We will be able to diagnose the disease by observing 
the following manifestations : In every case of acute coryza or influ- 
enza and in the exanthemata, we should keep in mind the possibilities 
of infection of the accessory sinuses. We should remember that the 
antrum of Highmore, the frontal sinuses and the anterior ethmoidal 
cells communicate with the nasal chamber through the middle meatus 
under the middle turbinate bone, while the posterior ethmoidal cells 
and the sphenoid sinuses open into the superior meatus, that is. above 
the middle turbinate and under the superior turbinate. Inflammation 
of the sinuses is usually ushered in with the general malaise attributed 
to la grippe, the severe bone-ache being generally well marked. In 
fact. 1 have seen the diagnosis of la grippe made when it should have 
been acute inflammation of the accessory sinuses. 



294 MEDICAL SOCIETY OF NEW JERSEY. 

Pain is a prominent symptom. It may be in the brow and eyes 
with photophobia, or there may be tenderness over the antrum. The 
muscles of the head and neck may be stiff, and not infrequently there 
is a tendency to mental depression. The symptoms are modified 
according as the ostium remains open or becomes closed. In the 
former condition secretions drain away more freely, and a spontane- 
ous cure frequently results, while in the latter there is retention and 
An aggravation of symptoms. Pain is not always a reliable indication 
as to which sinus is involved, but clearly indicates that some one sinus 
is involved. 

Tenderness over cheek or forehead may be elicited upon slight 
pressure. The discharge varies in character. It is sometimes a straw- 
colored fluid, or blood stained, or muco-purulent. A free flow of the 
secretions is followed by cessation of symptoms. A stoppage of dis- 
charge increases the symptoms. The alternation in character of 
symptoms is very suggestive of sinusitis. The mucous membrane is 
red and swollen and the turbinates turgescent. If the middle turbin- 
ate is contracted with adrenalin, there will probably be found some 
discharge flowing from the middle meatus, which may be increased 
by inclining the head forward. The pulse is not much quickened 
and the temperature is raised but little. 

Transillumination, — Transillumination is not infallible, although it 
is of value in many cases. It may be interesting to know that this 
method of diagnosis was first demonstrated in 1885, by Dr. Hewson, 
of Philadelphia, and not by the medical profession of Europe. For 
this statement I have the authority of Dr. B. A. Randall. The cloud- 
ing in transillumination is not due to the presence of pus, but to the 
thickened mucosa or serum-Ailed tissues. If best results are to be 
obtained by this method, it should be used in a dark room with the 
electric light up to its full candle power. In cases of acute coryza, 
with severe frontal pain, we may expect to find frontal sinus or 
anterior ethmoidal inflammation. 

If the pain is in the cheek there is a probability of antral disease, or 
if it be of a boring character deeper in the head, there is an indication 
of posterior ethmoidal or sphenoidal inflammation. I have never 
seen a case of acute sinus inflammation without pain, but I have seen 
severe chronic cases with no pain. 

Treatment,— K^ to the method of treatment, let me repeat that it 
is the first duty of every physician to prevent disease. In these very 



ACCESSORY SINUSES OF THE NOSE. 295 

cases where serious consequences may be avoided if the physician will 
recognize the importance of a severe coryza and treat it both inter- 
nally and locally, and not allow the much despised " cold in the head " 
to go untreated and get well as best it may. Here he may find the 
opportunity to discharge that duty. There is no doubt that from a 
lack of effort to prevent disease is due a large number of the chronic 
sinus disease. 

The principles of treatment applied in these cases are based upon 
the ordinary rules of caring for a cold in the head. The first, and in 
my opinion one of the most important steps in the treatment of these 
acute inflammations, is to order the patient to bed and the enjoining 
of absolute quiet. This should be followed by securing thorough 
relaxation and diaphoresis by means of a hot bath, the frequent drink- 
ing of water or hot lemonade containing acetate or citrate of potash ; 
(he application of hot cloths to the head and the administration of 
calomel in one-quarter grain doses every hour until a full grain has 
been taken ; this to be followed by a saline cathartic. After the 
bowels and skin are active, the ice bag to the head may replace the 
hot cloths, and the administration of atrophine should be instituted. 

The rhinitis tablet which contains camphor, atropine and quinine 
acts very well. It should be given until the mucous membrane 
of the nose and mouth become somewhat dry or the face is flushed 
or the pupils dilated. 

Belladonna seems to have a selective action upon the mucous mem- 
brane lining the nose and sinuses. By its use we certainly are often 
enabled to abort a coryza or a sinusitis. Locally, free drainage and 
thorough cleansing of the parts can be effected by a warm spray of 
Dobeil's or Siler's solution and the application of adrenalin solution 
(5 i ss to oz.)» either on pledgets of cotton or by gently spraying into 
the nostril, followed by a light spray of menthol, camphor and liquid 
vaseline, if the latter does not produce sneezing. The use of cocaine 
in the acute cases is objectionable because of its toxic effect and 
because of the secondary swelling of the turbinates which follows 
after the effect of the cocaine disappears. 

If the case goes on to suppuration and is not relieved by the abov^ 
treatment, it may be necessary to wash out the sinuses with a warm 
saline or boric acid solution or a solution of creolin. When suppura- 
tion is present, cocain and adrenalin should be used to facilitate the 
introduction of the catheter. If it be impossible to wash out the 



296 MEDICAL SOCIETY OF NEW JERSEY. 

antrum after removal of the anterior portion of the middle turbinate, 
a trocar should be plunged into the antrum through the nasal wall, 
under the inferior turbinate. The bone is here thin and may be easily 
punctured. The cleansing fluid should be forced in until it escapes 
from beneath the middle turbinate. It will be found that a few wash- 
ings usually suffice, unless thickening with granulation has already 
taken place. The bleeding which occurs from a turbinotomy is of 
decided value in lessening the congestion of the parts. While I have 
never seen death occur directly from the acute infection, I have seen 
it occur as the result of the chronic inflammation. 

In conclusion, permit me to say that not a few of this class of cases 
will recover without treatment, but that does not excuse us for not 
recognizmg the condition and satisfying ourselves that the patient is 
put in the best possible position for recovery. 

DISCUSSION. 

Dr. George E. Reading, of Woodbury.— I wish to add one point 
with regard to the treatment. Dr. Wilson has recommended bella- 
donna very highly, and while seconding this, I would say that if 
aconite is added to the belladonna the result it better, and it is less 
likely to be associated with unpleasant symptoms arising from the 
action of the belladonna. My attention was called to this combina- 
tion a number of years ago in connection with middle ear disease. 
This led me to use it in all acute catarrhal conditions of the air pas- 
sages, and I have found it capable of giving much belter results than 
belladonna alone. 



Surgical Interference in Abdominal Contusions. 

BY EDWARD A. Y. SCHELLENGER, M. D., CAMDEN, N. J. 

Many of us have seen death follow contusions of the abdomen ; 
whether the contusions were caused by blows, kicks, or the passage 
of heavy bodies, such as vehicles, over the abdomen. The surface 
gives us, in many instances, but meagre information, and it is only the 
autopsy that reveals rupture of the bowels or tear of the mesentery, etc. 

At such a post-mortem the surgeon asks himself : *' Why did not I 
operate ? " but he is liable to halt again and again before similar 
cases. 

The abdominal walls may be but slightly injured, and yet the 



ABDOMINAL CONTUSIONS. 297 

gravest internal lesions may co-exist. Despite the fact that there are 
practically no surface indications of injury of the internal organs, in 
the majority of cases we find alarming symptoms, /. e,^ such as 
agonizing pain in the region of the injury, restlessness, nausea or 
vomiting, marked prostration, rapid and irregular pulse, pallor, cold 
sweats and rigidity of abdominal walls. The surgeon is called 
upon to decide in such cases, and to decide without delay, for or 
against laparotomy. 

In this class of cases an operation at once performed may save a 
life, while a delay of twelve or twenty-four hours renders such an 
operation of no value. 

There are certain symptoms which, to my mind, indicate an imme- 
diate exploratory incision. 

it is my opinion that where a diffused rigidity of the abdominal 
wall is found, even in the absence of any other serious symptom, we 
are warranted in at once performing laparotomy. 

Hartmann reports ten cases of this kind, all operated upon, with 
nine recoveries. In seventeen cases where this sign was absent no 
operation was deemed necessary and all recovered. So here we have 
a symptom which cannot be passed by, and by which, if we follow its 
guidance, we may certainly save a few otherwise hopeless cases. 

The vomiting following these injuries varies from mere nausea to 
the most violent expulsive efforts. Vomited matter may contain 
blood. Constant and persistent vomiting tends to indicate visceral 
injury. 

The degree of shock depends especially upon the amount of blood 
lost ; therefore if the signs of collapse gradually become more marked 
internal hemorrhage is to be feared. 

The pulse is usually rapid and weak ; an unfavorable symptom is 
rapidity of pulse and increased tension. 

Fowler (A^. Y, Medical Journal) says after an abdominal injury 
if there is tenderness, acceleration of the pulse tending to increase ever 
so slightly, together with abdominal distension, the diagnosis of grave 
injury is absolute. 

The size of the instrument which caused the injury is an important 
factor in establishing a diagnosis. Lesions of the digestive tract are 
most frequently the result of sudden and violent percussion produced 
by some body over a limited surface of the abdominal wall. 

The predisposing factors are the presence of solid, semi-solid or 



298 MEDICAL SOCIETY OF NEW JERSEY. 

fluid matter in the hollow viscera ; leanness of the individual and 
intestinal adhesions. These conditions being present, rupture of some 
portion of the gastro-intestinal tract is likely. And when there is loss 
of consciousness at the time of the accident followed by a collapse, 
severe pain, rapid and weak pulse, vomiting and rigidity of the 
abdominal walls, laparotomy is unquestionably called for. 

In some confusing and perplexing cases we get a history of an 
abdominal injury either from kicks or blows or the like in which we 
find only slight pain, some or no shock, pulse a little above normal, 
slight nausea and slight rigidity of the abdominal walls. It is such 
cases as these that demand our most vigilant watchfulness ; and when 
in three or four hours we iincf the pulse weakening, or vomiting 
becoming persistent, or diffused rigidity of the abdominal walls, I 
believe laparotomy is the only sane method of treatment. 

I recall two cases of my own in which, if the above line of treat- 
ment had been followed, the patients would undoubtedly have been 
saved. 

A. B., a young man aged twenty-seven, was struck in the upper 
portion of the abdomen by the handle of a brake-wheel on a trolley 
car. At the time he experienced some pain and a sick stomach, but 
was able to run his car two or three miles. The pain becoming 
severe, with vomiting, he was taken home. An examination made 
about three hours after the injury revealed localized pain, weak pulse, 
a temperature of 100^ F., some rigidity, with vomiting. Four hours 
later I saw him again. The pain had increased, the vomiting was 
constant, and the rigidity marked. I delayed operating although the 
three symptoms which I now lay so much stress upon were present, 
viz., abdominal rigidity, constant and persistent vomiting and an accel- 
erated pulse tending to increase. I determined to operate the next 
morning, but his condition was such that anaesthesia meant certain 
death. He died at 2 P. M. Post-mortem disclosed blood and fecal 
matter in the peritoneal cavity and two perforations of the small 
intestine. 

The second case, C. D., a man aged forty-three, was struck in the 
abdomen by a piece of wood hurled from a revolving fly-wheel* 
Severe pain following the patient fainted, but in a short time he was 
able to walk some eight blocks to the hospital. An examination 
revealed no external lesion, very little tenderness and no rigidity. 
His pulse was 82 and his temperature 97.3 F. This was in the morn- 



CORNEAL ULCERATION. 299 

ing. He was put to bed. At 5:30 in the afternoon I saw him again. 
Found a pulse of 108, marked tenderness, tympanitis, persistent vomit- 
ing but not constant, with rigidity of the abdominal walls. The 
following day these unfavorable symptoms were increased. I operated 
and found rent in small intestine. Patient returned to bed collapsed, 
and died six hours after the operation. I believe that an exploratory 
incision made early would have saved his life. 

Murphy (Chicago) considers hyperaesthesia of the abdomen with 
respiration of 28 or 30 with nausea an absolute indication for opera- 
tion. As an example, a man was struck in the abdomen while run- 
ning a board through a planer. Intense pain followed with vomiting. 
On removal to hospital hyperssthesia of the belly walls was found 
with nausea, vomiting having ceased, and a rapid pulse. Was oper- 
ated on two hours after the injury. Found abdomen full of blood, 
rent in under surface of liver and rupture df small intestine. The 
perforation .of intestine was closed, the laceration of the liver was 
packed with iodiform gauze, and patient was put to bed in a serious 
condition. Intravenous injection of salt solution and stimulants were 
given and the patient entirely recovered. In this case delay would 
unquestionably have been fatal. 

Permit me to remark in closing, that in the light of our present 
knowledge, it can hardly be questioned that cases showing by their 
symptoms, as indicated above, a grave injury, ought to be sub- 
mitted to surgical measures as early as possible. Only a positive 
conclusion based on every means of diagnosis available will warrant 
the assumption that no serious injury is present, but where doubt 
exists, abdominal section alone is capable of insuring the patient 
adequate protection. 

If such section reveals but slight injury, no harm will have been 
done ; but if lesions of the organ be found, or serious hemorrhage be 
discovered and properly dealt with, the patient will have received the 
benefit of all our professional resources. 



Corneal Ulceration Due to Nasal Infection. 

BY S. LEWIS ZIEGLER. M. D., 

ATTENDING SURGEON WILLS' BYE HOSPITAL, OPHTHALMIC SUKGEON ST. 

JOSEPH'S HOSPITAL, PHILADELPHIA. 

The micro-organisms generated in the nasal cavities and accessory 
sinuses of the head have been gradually assuming their proper import- 
ance as pathogenic factors in ocular disease for more than a decade 



300 MEDICAL SOCIETY OF NEW JERSEY. 

past. Ziem*, in his admirable monograph, states his belief that ** two- 
thirds of all cases of ocular disease arise from nasal disturbances." 
The writer*, in a paper presented some nine years ago, made the fol- 
lowing statement : " I think we may safely say that fully ninety per 
cent, of corneal lesions take their origin directly from pre-existent 
pathological processes affecting the intra-nasal tissues and secretions. 
Careful inspection will almost invariably reveal associated lesions of 
the eye and nostril of the same side, which is most markedly shown 
where the disturbance is confined to a single eye and the correspond- 
ing nostril." 

There are three different avenues for the transmission of disease 
from the nose to the eye — (i) by the lacrymo-nasal duct, (2) by the 
blood and lymph streams, and (3) by reflex action through the nervous 
system. Although bacterial invasion has been traced through the 
blood and lymphatic circulation, we will only consider their transmis- 
sion through the lacrymo-nasal canal. In order to still further limit 
our discussion, we will confine our attention to ulcerative lesions of 
the cornea. 

The cornea is probably the most vulnerable tissue of the eye, 
owing to its anterior location and its consequent exposure to trauma- 
tism and infection. Any inflammation of the corneal substance may 
so affect its transparency that vision may be partially impaired, or 
even lost, especially where the resulting opacity is centrally located. 
Such lesions should, therefore, receive early recognition, and have 
efficient treatment promptly applied, in order that any disturbance of 
the visual acuity may be prevented. 

For our present purposes, corneal ulcerations may be subdivided 
into three varieties, the simple, phlyctenular and sloughing. 

Simple corneal ulcer appears as a small gray or grayish white 
lesion of the corneal surface, accompanied with pericorneal injection. 
Phlyctenular ulceration manifests itself as a pustule or vesicle, to 
which is attached a narrow leash of blood vessels. Either of these 
varieties may become suppurative in character, or even result in per- 
foration of the cornea, if proper treatment is not promptly instituted. 

Accompanying these local symptoms is a characteristic clinical pic- 
ture that cannot fail to indicate the diagnosis. There is intense 
photophobia, which the child attempts to alleviate by burying its head 
in a pillow or in the folds of its mother's dress. There is marked 
blepharospasm, the lids being gripped together so tightly that it is 



CORNEAL ULCERATION. 3OI 

almost impossible to open them. Lacrymation is often excessive, and 
occasionally a muco-purulent discharge is present. The nasal secie* 
tions are viscid, acrid and irritating, often hanging down on the lip 
and causing eczematous excoriation. Occasionally the face is co\ ere d 
with an aeneous eruption, and the skin of the whole body appears 
ashy-pale, relaxed and leaky, being bathed in perspiration, while the 
hair is matted together by the excessive moisture present. In cold 
weather the perspiration and chilliness of the body surface leads to 
excessive zeal in overdressing, which only adds to the existing trouble. 

Sloughing ulcer usually arises in two ways, (i) from some small 
wound of the cornea, which is either infected by some germ-deposit 
carried on the foreign body itself, or, more frequently, by the excessive 
bacterial growth occurring in the tear-duct ; and (2) it may also 
occur in the course of the exanthemata or other fevers, (a) by infec- 
tion with excessively virulent bacteria, following maceration and lesion 
of the corneal surface through acrid secretions, and {d) by actual local 
pustulation. The rapid break-down of the cornea, the wide extent of 
the ulceration, the muco-purulent discharge, and the extreme physical 
prostration of the patient will promptly indicate the more serious 
character of this lesion. 

The pyogenic germs may penetrate the corneal layers before there 
is actual perforation, and cause what is termed hypopyon, or pus in the 
anterior chamber. In the simple or phlyctenular ulcer this material 
will be promptly reabsorbed ; but in the sloughing variety a more 
serious infection may result. 

The nasal etiology of these corneal lesions involves many factors. 
The inspired air carries into the vestibular air chambers innumerable 
spores, many of which are retained and undergo fermentation, because 
of the essential elements of heat and moisture present. The acces- 
sory cavities furnish in still greater degree these fermentative possibil- 
ities. If, then, their mucus contents become infected by these 
invading organisms, almost unlimited multiplication will occur. So 
long as the secretions can escape freely, the bacteria are washed out 
by the flux. When, however, partial or complete occlusion of th^ 
sinus orifice occurs, a veritable bacterial pest-house or breeding 
ground for germs is thereby established. 

The accessory cavity that is chiefly involved in these processes is 
the maxillary sinus or antrum of Highmore. Its location, its ease of 
obstruction, and its anatomical conformation as a pear-shaped sac 



302 MEDICAL SOCIETY OF NEW JERSEY. 

with a superior opening (thereby permitting retention of all fluids 
except the overflow), all tend to make this cavity what is practically a 
semi-closed cess-pool filled with the pathologic products of decomposi- 
tion and fermentation. We must agree with Bos worth' when he says 
that "it is an invariable rule that a catarrhal secretion in a closed 
cavity must give rise, sooner or later, to a purulent discharge." 

The mucous membrane composing the orifice and the canal, which 
is the means of exit from the antrum, is oftentimes tortuous in its 
passage through the bone ; it may be loosely adherent and thrown up 
in folds ; it may be unusually susceptible to vascular dilatation and 
engorgement ; or it may be easily irritated by the outflow of acrid 
secretions. Atmospheric humidity and low barometric pressure may 
cause venous stasis. Hyperesthesia of the Schneiderian membrane ; 
the irritation set up by contact of the intra-nasal mucous surfaces 
themselves ; the local irritation of particles inhaled in breathing ; the 
influence of heat and cold, either local or systemic — one or all of 
these conditions present will quickly demonstrate how easily this 
small canal may become partially or wholly occluded, thus shutting 
off the antral cavity. 

The mucous membrane lining the antrum is likewise subject to 
certain pathologic changes. There may be simple hyperemia with 
hypersecretion due to chilling of the surface of the body. If this 
chilling suddenly checks perspiration, the normal amount of urea 
excreted by the mucous membrane of the antrum is considerably 
augmented by the vicarious action which it assumes in order to help 
eliminate the excess of urea in the system. The congestion and closure 
of the antral orifice creates, therefore, what is practically a cyst or 
bladder, and we have set up by means of the bacterium urea, a path- 
ologic process which is a pure analogue of cystitis as it occurs in 
the urinary bladder, and which will run a similar course. The urea, 
through a bio-chemic action, changes into ammonium or ammonium 
carbonate, both of which are intensely irritating to the mucous Itiing 
of the cavity, and at the same time the excessive alkalinity coagulates 
the mucus contained therein. The fluid serum continues to be 
secreted, and thus the coagulated mucus rises to the upper portion of 
the chamber, and because so coagulated is extruded into the nasal 
cavity with dlfiiculty. 

If, now, we concede an infectious cystitis of the antrum, we can 
comprehend how it is possible for an unlimited stream of pathogenic 



CORNEAL ULCERATION. 303 

micro-organisms to be poured out onto the cup*Iike floor of the nasal 
chamber, and by capillary attraction drawn up into the lacrymo-nasal 
duct, and thence to the ocular cul-de-sac. 

The lacrymo-nasal duct itself is, moreover, a most fertile nidus for 
this bacterial development. The presence of strictures, viscid secre- 
tions, ulceration of the lining membrane, or interstitial thickening of 
the same, all tend to interfere with its syphonic action in the down- 
ward drainage of the tears. The bacterial growth is greatly facili- 
tated by the consequent stagnation. Not only are the tears prevented 
from passing into the nose, but microbic infection is carried upward 
to the eye by the regurgitation of these septic secretions. 

Whether the actual break in the corneal epithelium is due to the 
maceration caused by this acrid alkaline fluid, or whether there is a 
direct erosion due to adhesion of the bacterial colony is immaterial. 
We believe that both pathologic processes are possible. Of course, 
corneal abrasion by direct traumatism is always a possibility. The 
friction of rough granular lids may thus become a causative factor. 

The micro-organisms that have been most frequently found in these 
conditions are the pneumococcus, the staphylococcus, and the Klebs- 
LoefSer bacillus, while the streptococcus and the gonococcus of 
Neisser are more infrequent factors of infection. 

We must not overlook the fact that there is a constitutional element 
in the disturbance—chronic constipation, errors in diet, poor food, 
and unhygienic habits are important factors to be considered. Nasal 
obstruction and mouth breathing are especially deleterious, because 
orally inspired air cannot evaporate intra-nasal fluids, and because 
lowered oxidation and metabolism almost invariably results. 

In children the exanthemata are immediately or remotely respon- 
sible for many of these conditions, while teething is often a causative 
agent. In hospital work, however, I have found the most unvarying 
genetic factor to be over-indulgence in coffee^ tea and sweets. They 
sap the vitality and create a peculiar gastro-intestinal irritability that 
is hard to overcome, and which reflexly adds to the nasal disturbance. 
When taken in excess they overload with Xanthin compounds an 
a^^eady weakened system, and like alcoholic excesses, inhibit proper 
elimination of the system's waste, thus resulting in what is practi- 
cally katabolic stasis. 

Having thus briefly reviewed the etiology of this disease, we may 
properly characterize corneal ulcer as a purely local inflammatory 



304 MEDICAL SOCIETY OF NEW JERSEY. 

process, arising chiefly from infection by septic lacrymo-nasal 
secretions, and frequently complicated by lowered oxidation and 
metabolism. 

TREATMENT. 

I The Nose. — The nasal origin oC this affection indicates the 

i treatment to be applied. Irrigation of the nasal chambers with an 

antiseptic or saline solution should be carefully carried out. If pus 
is present, hydrogen peroxide (diluted i to 4) should be dropped into 
the nostril by the ordinary eye-dropper, two or three times a day, and 
allowed to trickle back into the throat. 

Local applications for the reduction of the turgescent mucous mem- 
branes are often necessary. A weak solution of cocaine (i to 2^ may 
be applied with cotton wrapped on a wire applicator. This may be 
followed by an application of — 

9 Camphor 

Menthol aa gr. x 

Tr. Benzoin Comp f 5ij 

Boroglyceridi (50^) q. s. ad f S j 

M. et Sig. Apply to nose daily, or on alternate days. 

If any more serious naso-pharyngeal lesion is present the patient 
should be promptly referred to the rhinologist for relief. Enlarged 
tonsils or adenoid vegetations in the pharynx, and septal spurs, poly- 
pus or other nasal growth should have surgical attention. If the 
ocular condition has become chronic it may be necessary to reduce 
the hypertrophied and turgescent inferior turbinates by galvano- 
cauterization. The object to be accomplished by such a procedure is 
threefold — to promote free antral drainage, to secure freedom from 
pressure contact, and to obtain free nasal breathing. 

The Tear Duct. — The lacrymo-nasal duct maybe active or passive 
in the transmission of germs. It may contain septic secretions with- 
out a show of pus. and the amount escaping through the puncta into 
the eye may be so small as to be practically invisible. If the nasal 
swelling is reduced, the turgid condition around the valve of Hasner 
will be lessened, and the secretions will have a natural downward 
drainage. Ocular irrigation may aid this somewhat. Pressure on the 
membranous duct will often empty its contents. The small canula of 
a lacrymal syringe may be introduced into the puncta and very gentle 
irrigation attempted. If these measures fail it is evident that a patu- 



CORNEAL ULCERATION. 



305 



lous tear-duct must be secured either by incision or by rapid dilata- 
tion. Such surgical intervention naturally demands the services of 
the ophthalmic surgeon. 

As incision of the tissues often leads to cicatricial contraction, I 
prefer the method of rapid dilatation without incision, which I have 
practiced for some fourteen years past. This is done by first intro- 
ducing a needle-probe into the lacrymal puncta and passing it through 
the previously stretched membranous canal to the bone. It is then 
withdrawn and my conical dilator with a maximum size of a No. 10 
probe is passed through the membranous canal, and thence, by gentle 
force, through the bony canal into the nose. 




*DR. ZIEGLERS LACRYMAL DILATOR AND NBKDLE PROBE. 



While the general shape of the dilator is conical, it is rounded or 
bellied just above the point, which allows it to dilate so rapidly that 
the point does not engage, and the dilator never becomes wedged as 
with a simple cone. The needle-probe has the same quick expansion 
just back of the point, which is sharper tlian that of the dilator. 

The advantages of this method are the avoidance of cicatricial con- 
traction about the lacrymal puncta, and the preservation of capillarity 
and syphonic action; thus directing the current of lacrymal drainage 
toward the nasal orifice. A repetition of this procedure is seldom 
required. 

Where, however, blenorrhea of the sac, lacrymal abscess or 
marked caries is present, incision should be promptly made, rapid 
dilatation performed, and a lead style inserted. This should remain 
for one week, and be followed by lacrymal irrigation. 

In very exceptional cases of corneal infection it may be necessary to 
prevent the regurgitation of these septic secretions by sealing up the 
lacrymal puncta with the galvano-cautery point, or with a crossed 
suture. 



"Made by Ferguson, and by Schneyder and Allen Co. in Philadelphia, and by 
Meyrowitz in New York. 

20 



306 MEDICAL SOCIETY OF NEW JERSEY. 

The Eye. — In simple and phlyctenular ulceration of the cornea the 
treatment to be employed is somewhat similar. A mild soothing 
lotion should be freely applied to the eye, consisting of 

Jl Sodii Biborat gr.v 

Ac. Boric gr.x 

Aq. Rosae 

Aq. Destillat ....m. fSj 

M. et Sig. Drop in the eye freely, four times a day. 

If the iris is at all sluggish atropia should be instilled. If the pupil 
dilates freely its further use should depend on circumstances. 
Calomel, or iodoform with compound stearate of zinc, may be insuf- 
flated or used in an ointment. Hot stupes for ten minutes three times 
a day may be beneficial. A pressure bandage is occasionally useful, 
but should be closely watched as the added warmth may increase 
the bacterial growth. 

Argyrol, in strengths of from lo to 20j^, will prove beneficial, both by 
its antiseptic action on the ulcer itself, and also by its sedative action 
on the congested conjunctiva. The staining it causes is only tempor- 
ary, as it is perfectly soluble in water. It possesses the important 
advantage of causing neither pain nor irritation. 

Sloughing ulcer will require more vigorous treatment. The eye- 
lotion previously mentioned, or bichloride solution, i to 8.000, should 
be used freely every houc or two. Ice compresses should be 
applied continuously day and night. Atropia should be instilled 
three times a day. Iodoform may be dusted in, or used as an oint- 
ment. 

If the ulcer tends to spread, cauterization by the galvano-cautery or 
by carbolic acid may be employed. I prefer, however, a i^ solution 
of formalin, which is applied daily, under cocaine anaesthesia. A 
small bit of cotton is wrapped tightly on the end of a wiro appli- 
cator. Dip this into the solution, wipe off all excess, and rub 
lightly but carefully over the ulcerated surface. The healthy tissue 
should not be touched as some pain and irritation may result. The 
formalin method has this double advantage ; it does not destroy 
corneal tissue, and it prevents or clears up a great part of the opacity 
which is so liable to result. It must, however, be used with great 
care. 

The System,— Tht general treatment should be dietetic, hygienic, 
and tonic. 



CORNEAL ULCERATION. 307 

Errors of diet should be at once corrected. Coffee probably 
causes the most harm, although sweets are undoubtedly a close 
second. My invariable formula for children is "no tea, no coffee^ no 
cakes and no candy** Salt water baths with friction, followed by an 
alcohol sponging will tone up the relaxed skin. Proper physical 
exercise will promote oxidation. The bowels should be carefully 
regulated. A one grain tablet of cascara every night may prove 
useful. The granular phosphate of soda is a saline aperient, correct- 
ive and cholagogue, and especially valuable for children. Calomel is 
both antiphlogistic and a stimulant to the dormant lymphatic system. 
The'syrup of the iodide of iron is frequently indicated. Where there 
is debility or prostration, milk punch will revive the vital forces. The 
following tonic mixture has proved its usefulness : — 

^ Hydrarg. Bichlor gr.j 

Liq. Pot. Ars f 3ij 

Tr. Ferri Chlor fSiv 

Ac. Phosph. Dil ^ Sj 

Syr. Limonis q. s. ad f Siv 

M. et Sig. Take a quarter to one teaspoonful in water after each 
meal. (Dose according to age.) 

To briefly eptomize the treatment : 

I. The nose should have antiseptic irrigation and local treatment 
applied. 

2 The lacrymo-nasal duct should be disinfected or dilated. 

3. The eye should have a soothing lotion, a mydriatic instilled, and 
a cauterant applied to the ulcer if necessary. 

4. The diet should be regulated, tonic and antiphlogistic treatment 
given, and the hygiene generally improved. 

1. Mon. f. Ohr., 1893, Nos. 8 and 9. 

2. N. Y. Med. Jour., Nov. 3, 1894. 

3. Diseases of the Nose and Throat. Vol. i, page 466. 

DISCUSSION. 

Dr. W. P. ;Eagleton, of Newark.— While it has long ago been 
pointed out that 90 per cent, of corneal ulcers are associated with 
nasal lesions, but it has not been demonstrated that the ulcers are due 
to the nasal lesions. The advisability of dilating the duct will 
depend upon whether it is closed or not. Where there is pus coming 
from the duct there is no doubt that dilatation is called for, but if 



308 MEDICAL SOCIETY OF NEW JERSEY. 

there is no closure of the duct such heroic treatment may do more 
harm than good. It has been my experience to sec very severe 
lachrymal abscesses follow dilatation of the nasal duct, thereby giving 
the patient a more serious and painful trouble than before. To 
determine whether or not the duct is patulous, I have found it useful 
to apply to the conjunctival sac a drop of solution of fluorescein. If 
the duct is pervious, the discolored tears are carried down into the 
nose. In two or three minutes the patient blows the nose, and the 
discolored tears are found in the nasal secretion, thus demonstrating 
that the duct is open. In a few cases in which I have tried this 
method it has been found very satisfactory, and its employment will 
often make the heroic measures advocated in the paper unnecessary. 



Court Testimony of Medical Experts in Mental 

Diseases. 

BY B. D. EVANS, M. D., MORRIS PLAINS, N. J., 

MKDICAL DIRECTOR OF THE NEW JERSEY STATE HOSPITAL AT MORRIS 

PLAINS. 

In carrying out the ends of justice, complex and abstruse problems 
present themselves. The judges of our courts are supposed to be 
well versed in law in its general application, but no jurist can be 
conversant with its special applications to the various sciences, arts, 
professions and callings ; for such a knowledge would mean that to 
be a competent judge of the courts one would be required to 
have expert knowledge of every department of human activity. The 
limitations of the human intellect are such as to clearly render this 
an impossibility. When one man masters his profession, or even a 
particular branch of his profession, he has labored well, and has 
accomplished that which entitles him to have his name enrolled in 
the galleries of the world's great men, and we honor him, and speak 
of him as an authority, distinguished, eminent, or famous. It is, 
then, clear that the calling of experts, or specialists, before our courts 
of justice is not only expedient but highly necessary for the elucida- 
tion of complex questions arising in the domain of the various sciences, 
arts and professions. 

The specialist in mental derangements is called into court as a rule 
where there is a question as to criminal responsibility, testamentary 



COURT TESTIMONY OF MEDICAL EXPERTS. 309 

capacity or contractual capacity. This summed up means that he is 
called as an analyzer and elucidator of nearly every relation one 
human being may have to another. Upon the expert in mental dis- 
eases there rests the responsibility of weighing acts, normal and 
abnormal, of dealing with questions and qualities tangible and intan- 
gible. Upon his power of analysis and discrimination often hangs 
human life, liberty, happiness and the distribution of property. He is 
not simply an expert in diseased processes incident to mental derange- 
ment, but must judge of the soundness of mental operations as exhib- 
ited by the subject's words and acts as well as the full scope and 
bearing such words and acts may have. It is, therefore, plain that 
however wide the field of mental operations, and into whatever 
departments of human action the subject may have played his part, 
the expert, to do his full duty, must analytically sum up his entire 
life, and even look into the nervous make-up of generations before 
him, who may have transmitted to him a neurotic taint. 

All the factors which have been prominent in the make-up of his 
intellectuality must be considered ; his associations, occupation or 
profession, and the qualifications necessary for such occupation or 
profession. So that to analyze the qualities, qualifications and quan- 
tities involved, and discriminate as to the proprieties and improprie- 
ties, to determine which acts are in harmony with one's education, 
associations, opportunities and temperament, calls for more than a 
knowledge of the pathological findings characteristic of certain forms 
of mental diseases. 

The object of introducing expert testimony into court proceedings 
should always be to make clear scientific points relating to the ques- 
tion at issue, and thus promote the best principles for the government 
of society and the protection of life and property. But the application 
of justice and equity to the principles of medicine is a vastly different 
problem from that of applying the principles of medicine to the 
requirements of law. 

Medicine is progressive. It does not to-day depend on the dogmas 
and theories of the middle ages ; it does not hang even to the theories 
offthe last decade, but accepts that which is proven to be the sound- 
est and best after being subjected to scientific scrutiny and careful 
analysis. No great authority of the past is allowed to retard the 
investigations of to-day, or to interfere with the progressive strides 
which are being made through scientific research in the interests of 
humanity. 



3IO MEDICAL SOCIETY OF NEW JERSEY. 

In our courts of law we hear of conservatism, and in many import- 
ant cases before a decision can be reached or verdict given there must 
be a precedent found ; it matters not how mouldy with age this pre- 
cedent happens to be, it is necessary and must be forthcoming from 
some source. If none can be found under recent statutes, then resort 
is made to the common law as expounded by some jurist who wore 
the wig and gown, which are supposed to give sufficient force and 
dignity to his rulings, though an analysis fails to show them either 
erudite or profound. 

With due respect for the so-called conservatism of the law and 
high regard for the calm, deliberate methods followed by our courts, 
we still query as to how substantial progress can be made in rulings 
relative to the criminal responsibility of the insane so long as there 
are no means of getting loose from precedents and establishing tests 
in accordance with medical truths. 

New Jersey courts generally still hold that if the prisoner knows 
" the difference between the right and wrong of the act committed," 
that he is criminally responsible in the sight of the law. If this estab- 
lished ruling be the precedent upon which all future cases are to be 
decided, then progress is out of the question. Revelations in medi- 
cine, surgery, physiology and pathology can not change this fixed 
proposition, and the wheels of justice are destined to run in one 
gxed track. 

What is the proper course for the insanity expert ? Shall he try 
to make medical facts fit the demands of exploded and illogical legal 
dicta ? or shall he day by day strive by educational methods to make 
plain that his legal brother in some particulars is a veritable Rip 
Van Winkle, and that during his long sleep there has been steady 
progress in the world, and that intelligent research has shed much 
light upon what is known as the responsibity of the insane as viewed 
from the standpoint of justice and humanity. 

Medical jurisprudence was first taught in England in the sixteenth 
century. Sir Matthew Hale (born 1609, died 1676), whose decisions 
are still referred to by the courts, indulged in gross superstitions, and 
in support of some of them said: "There were such creatures as 
witches he made no doubt at all ; for the Scriptures affirm as much ; 
the wisdom of all nations had provided laws against such persons, 
which is argument of their belief in such a crime;" 

I do not feel at liberty to encumber this paper with a large number 



COURT TESTIMONY OF MEDICAL EXPERTS. 3II 

of quotations, or the citation of the numerous court cases with which 
I have been connected as a medical expert in New Jersey, New York 
and other States, but I trust I may have your indulgence in making a 
few select quotations which will in a measure set forth the lack of 
uniformity of eminent jurists, both in their knowledge of the medico- 
legal aspect of insanity and their appreciation of the medical expert. 

" Lord Chancellor Wcstbury, in the House of Lords, declared on 
the nth day of March. 1S62, that the introduction of medical opinions 
and medical theories into this subject has proceeded upon the vicious 
principle of considering insanity a disease." 

"Justice Doe, of New Hampshire, in the case of the State vs. Pike, 
said : " The legal profession, in profound ignorance of mental disease, 
have assailed the superintendents of asylums, who knew all that was 
known on the subject, and to whom the world owes an incalculable 
debt, as visionary theorists and sentimental philosophers attempting 
to overturn settled principles of law, whereas, in fact, the legal pro- 
fession were invading the province of medicine and attempting to 
install old, exploded medical theories in the place of facts established 
in the progress of scientific knowledge." 

In i860, the prisoner pleaded guilty, and Baron Bramwell, address- 
ing him, said : " That you are of unsound mind I believe, but that is 
no reason why you should not be punished. I address the explana- 
tion of the reasons why I pass upon you the sentence which I am 
about to pronounce not so much to your understanding as to those 
around who hear me, and to those whose duty it is to notice them. 
The law makes unsoundness of mind no excuse for offences, except it 
were such that you did not at the same time know the nature of what 
you were doing, and that it was wrong and unlawful. No doubt it is 
very unfortunate that persons of unsound mind should become by 
that affliction less under the influence of moral restraints and of 
restraints of law, but it would be sad indeed for the public if when 
those restraints are weakened, the protection of the law were to be 
withdrawn by the extension of impunity to crime. I am not sure 
that it is not more necessary to punish a madman than a sane man, 
so far as the protection of the public is concerned. I feel bound to 
sentence you to the same punishment as if you were sane." 

The Hon. Charles Doe, Chief Justice Supreme Court of New 
Hampshire, says in a letter to the Hon. Clark Bull, of New York City : 
" State V. Pike, to which you refer, was decided twenty years ago next 



312 MEDICAL SOCIETY OF NEW JERSEY. 

June. During that time I have looked in vain for a noticeable 
attempt to show error in the New Hampshire law on the subject of 
legal tests of insanity. There have been decisions affirming the old 
test of knowledge of right and wrong in criminal cases. It has been 
said that in some cases insanity aught not to be a defense. It has 
been said in substance that the New Hampshire rule is impolitic and 
dangerous ; that if insanity causes a man to do something which he 
knows to be wrong, and which would be criminal if he were sane, he 
should be punished for his mental disease. 

•* Many things have been said, but since the decision in the State v. 
Pike was published. I have seen nothing that can be regarded as a 
serious effort to grapple with the argument of the common law ques- 
tion, and show error in the New Hampshire rule. Jf any effort of 
that kind entitled to a moment's consideration in the judgment of a 
good common law lawyer, has been made since the publication of 
State V. Pike it has escaped my observation. 

•• I do not suggest that the legal argument in that case is unanswer- 
able. It may deserve no answer. It may be beneath the notice of sound 
lawyers. I merely ask if you are aware of, or can you find anything, 
that a sound lawyer would regard as an answer worthy of considera- 
tion. If you can find anything of the kind, would it be well to ask 
your readers why those who reject the New Hampshire rule have 
allowed twenty years to pass without making any noteworthy attempt 
to expose the error of it, or to attack it upon any ground of common 
law principle. The grounds of that rule are distinctly set forth in 
our decisions, and are in every library used by the judges and the 
leading lawyers of this country. 

*' If those grounds are too feeble to deserve an answer, let them go. 
If their feebleness will not consign them to oblivion, why has not 
somebody taken them up fairly, met them fully and squarely, and 
demonstrated their unsoundness by common law argument addressed 
to the legal intelligence of the country.^ Why don't somebody 
assume that easy task now } How long will it be before the candid 
minds of the profession will demand a satisfactory answer to these 
questions? Such minds are not swayed by superficial or general 
allusions or mere assertions. They insist upon argument, solid, 
thorough and profound, going to the bottom of the subject, free from 
cavil and sophistry, shunning no difficulty and misrepresenting no 
position of an adversary. I merely suggest in the course of your 



COURT TESTIMONY OF MEDICAL EXPERTS. 313 

writing on the subject, an appeal, perhaps in the interrogative form, 
to the candor of the legal profession for an explanation of the fact 
that twenty years have passed without any nnaterial answer being 
made to the New Hampshire argument on the common law question." 

Sir Edward Coke said : " To execute an insane person is against 
law and of extreme inhumanity and cruelty, and can be no warning 
to others." 

Mr. Justice Tracy said : To relieve from responsibility, insanity 
must be absolute ; a man must know no more than an infant or a 
wild beast." 

Chief Justice Bardsley ruled that "absolute insanity is not neces- 
sary, if the person was insane with reference to the crime charged, 
it was sufficient." 

So we might go on ad infinitum with decisions bordering on the 
grotesque; rulings of distinguished jurists conflicting on cardinal 
points, and all in the sacred name of the law. 

When medical experts differ, our legal brethren seem almost to 
scorn a profession in which there is no greater harmony of thought. 
The press having been represented at the trial by an expert in short- 
hand, publishes his criticism of the alienist in large, showy headlines, 
and at the corner grocery store, the critics there assembled say : 
"These doctors can't agree among themselves." 

The rulings of the courts are public acts and go upon record, and 
naturally, there is a certain pride felt in them, and once subscribed to, 
a recession from them calls for a sacrifice of dignity. But what 
physician of to-day would be bound in his treatment of disease by 
the dicta of Hippocrates, Galen or even the illustrious Sydenham } 

As a specialist in mental diseases, I claim that our courts can best 
serve the ends of justice by making a conscientious application of law 
to the principles of medicine as they are now. and not as they were 
believed to be by the legal profession centuries ago. 

We, as alienists, contend that when a delusion dominates a per- 
son so that he is unable to get away from its imperative force, 
he is "as a piece of clay in the hands of a potter," he is, because of 
this delusion, no longer a volitional being, but as a result of the 
false belief evolved and elaborated through disease, he is helpless and 
irresponsible. 

That medical men of marked ability should differ as to details 
relating to mental alienation, is natural and reasonable ; for medicine. 



314 MEDICAL SOCIETY OF NEW JERSEY. 

taken as a whole, like law, is not, strictly speaking, a science, but an 
art of the highest order. 

It is well known that great men in military strategy, naval problems, 
architecture, sculpture, astronomy, political economy and even 
mathematics have held to radically different opinions upon the same 
great problems, and yet have gone down in history as men of great 
merit, sincerity of purpose and promoters of the world's best interests. 

The medical expert should always keep in mind that he is a 
member of the noblest of professions, and that when called as a 
witness in his specialty, he is not present as an advocate. He should 
always keep before him the fact that his duty is to explain the 
principles of medicine as related to the question at issue. He is 
called, presumably, because he is qualified by training, research and 
experience to make clear to the court and jur>', facts not wiihin 
the grasp of the ordinary witness, and yet of vital interest in assisting 
the court to arrive at a just decision. 

His position is, therefore, a most honorable one, and if he exhibit 
the true qualifications of a medical expert, he will necessarily com- 
mand the respect of the court, and uphold the dignity of his profession. 

It is unfortunate for the medical profession that there are many 
self-constituted medical experts ; men who are willing to go upon 
the stand and attempt to give expert testimony upon any branch 
of medicine they have heard lectured upon. A physician who claims 
to be an expert in several branches of his profession is fairly sure to 
be well equipped in none, and as an expert, an imposter. 

It has been my misfortune to sit in court on several occasions and 
hear testimony by physicians who posed as specialists, but whose 
testimony was so crude that it embarrassed even the examining 
counsel. 

On one occasion I suffered the embarrassment of being called ir, 
a contested will case to confute the testimony of a young physician 
who had not seen ten cases of insanity in his entire pra.ctice, bm 
who claimed to possess the qualifications of an expert in mental 
diseases. He was kept on the stand for several hours, and during 
that time made three different and distinct diagnoses of the mentil 
ailment from which the testator was suffering, none of which vwerc it 
harmony with the symptoms as stated by him and by the other 
witnesses. 

There should be an effort made both by the medical a.nd lega^ 



COURT TESTIMONY OF MEDICAL EXPERTS. 315 

professions to establish a standard of qualifications for medical ex- 
perts ; and any physician desiring to practice in court as an expert 
in any special branch, should be required to qualify according to the 
legal standard so established, and upon nneeting the qualifying re- 
quirements he should be granted a certificate and be recorded in the 
office of the clerk of the county in which he has residence. 

Under such a course of procedure, the medical profession would 
be freed from much embarrassment, and the legal profession would 
better understand the value and skill of physicians whose services 
they need as counsel, in making clear the principles of medicine in- 
volved in court proceedings. 

There has justly arisen much dissatisfaction as to the manner of 
selecting experts, and the use of the testimony given by them ; ar.d 
it does seem clear that some legal regulation by statute could be 
adopted which would render this form of testimony more valuably, 
and at the same time facilitate court proceedings where the services 
of experts are deemed necessary. 

I have thought that if a law should be enacted that when medical 
testimony is necessary, the counsel on each side should have the 
power to select one expert and the presiding judge the third, and 
these three experts required to sit together and consider all available 
testimony and render their opinion in a conjoint deposition, the 
results would be uniformly more satisfactory, and add more dignity 
to the procedure as well. 

In this manner, the scientific opinions of judiciously selected men 

of ability would be brought to the aid of the demands of justice, 

,, ^\'^ and to the protection of the best interests of society by the dispassion- 

,^/ i ate elucidation of complex medical problems. This would dispose of 

«,t' the adverse criticism not infrequently made by opposing counsel, to 






:iC- 



the effect that experts were little short of paid medical advocates, 
as their remuneration under such course could not be said to depend 
^^^^ ]^. oi i- upon the character of their testimony. If this be not practicable in 
^'"^^ '\;. ;' . civil suits, it cannot be disputed that it would be attended with 
''^^ f i' ' gratifying results in criminal proceedings. 

iijons . j^ j^^g jj^^j^ j^y practice for years to prepare a carefully written 

^o*" ^ \^^^ medical brief in all important cases in which I am called as an ex- 
tiii^^ ' *,j :. pert. This was suggested to me by a nutnber of painful experiences 



.sn«^- 



no: 



ffenng- ^,. upon the witness stand. 

zd ^y ' On many occasions in my direct examination I found that the 



3l6 MEDICAL SOCIETY OF NEW JERSEY. 

counsel, though deeply interested in bringing out nriy testimony, was 
so unfamiliar with mental diseases and the necessary technical terms, 
that his questions were both embarrassing and confusing. On one 
occasion, the lawyer examining me asked the same question seven 
times, and I believe he would have asked it seven more if I had not 
told him I had answered it so often that I was tired ; and the per- 
plexing feature of the situation was that it was irrelevant, and my 
answer, if at all responsive, could shed no light upon the question, or 
be of any value to him or his cause. After going through numerous 
ordeals of this kind, I came to the conclusion that I could better serve 
the paramount interests involved by preparing in each case a medical 
brief. 

In these briefs I sum all the evidence given and all that the counsel 
assures me will be given relating to the family history of the subject, 
his delusions, illusions and hallucinations (if he has any), the charac- 
ter of the acts performed, the conditions under which it was done, the 
absence or presence of motives, his relations to the person or persons 
affected by the act in question, his educational advantages, his habits 
of daily life and the duration of his alleged mental derangement. I 
make a diagnosis ; I give the typical symptoms and characteristics of 
the form of mental disease which I have decided the subject to be 
suffering with. 

This is followed up with conclusions as to the existing responsibility, 
testamentary capacity or contractual capacity under such abnormal 
conditions of mind. 

These points clearly set forth need only to have the standard 
authorities on insanity in its medico-legal aspect quoted in writing to 
substantiate or reinforce the conclusions and opinions laid down, 
and with this done, the brief is completed in duplicate. One copy I 
give to the counsel that he may fully understand my views, as well 
as those of the accepted authorities on the question. If other 
physicians be associated with me, I submit my duplicate to them, 
that we may confer upon any important points where there is room 
for difference of o|)inion in detail. 

When I go upon the stand, the counsel approaches the work of 
examination with a confidence that is born of knowledge and prepara- 
tion, and the wheels of justice run smoothly as they go over the 
medical portion of the track. 

I commend to all medico-legal experts the preparation of such 



COURT TESTIMONY OF MEDICAL EXPERTS. 317 

briefs, and assure them of their appreciation by the counsel, to say 
nothing of the improvement in the tone and general character of the 
examination to follow. 

The responsibilities of the conscientious medical expert are many, 
his perplexities are legion, but in the highest conception of his duties, 
his mission is a noble one. To traverse the entire field of his 
activities even in a general manner, would mean the writing of a 
treatise. 

I wish to conclude this paper with some terse suggestions to the 
medical expert in mental diseases with special reference to court 
work. 

He should use every legitimate means to know his case thoroughly 
in all its details before going upon the witness stand. It is highly im- 
portant that he should be calm, deliberate and dignified while 
testifying, always bearing in mind that deliberation, within bounds, 
is far more creditable, and more characteristic of ability than sharp 
repartee, and that while *' legal evidence is composed of testimony, 
all testimony is not necessarily evidence in law," and that dogmatic 
evidence convinces neither the court nor the jury. 

He should speak clearly and distinctly and sufficiently loud to be 
easily understood by all who are entitled to hear him. 

There is nothing more calculated to detract from the weight of his 
testimony than his assuming the role of an advocate. 

Prepare a carefully written brief, that the counsel may be by its aid, 
made familiar with your views on the issue and more conversant with 
all necessary technical medical terms, as well as some of the standard 
authorities in harmony with your conclusions. But it is the course 
of wisdom to avoid the use of all unnecessary technicalities, or such 
strictly medical terms as are calculated to confuse counsel or jury. 

The display of irritability of temper is never in order, and can 
only result in leaving an unfavorable impression upon, not only 
those directly interested, but upon every one present. 

It is not the course of wisdom on the part of the expert to assume 
to know something which he does not, nor should he hesitate to 
say ** I do not know," when such is the fact ; for while he may be 
a well-qualified expert, no one can reasonably expect him to be a 
medical encyclopedia. 

He should, above all things, preserve his dignity and mental poise 
when nagged at by small-calibred lawyers. 



3l8 MEDICAL SOCIETY OF NEW JERSEY. 

It is always the part of wisdom to be frank in answering fair 
questions, but he should not allow himself to be forced into giving 
an answer of "yes" or "no." when such an answer does not fairly 
represent his views. Hypothetical questions are often so framed 
that they cannot be so answered with justice to the witness or the 
issue in question. 

To be drawn into petty arguments is unwise, even if the court be 
so patient as to allow it. He should always keep in mind the fact 
that he is a physician, and as a physician, a gentleman, and a pro- 
moter of order and justice. 



Extensive Fracture of Skull. Insertion Cel- 

LUOiD Plate. Traumatic Epilepsy and 

Relief by Subsequent Operations. 

BY JOHN C. MCCOY, M. D., PATERSON, N. J. 

The history of traumatic epilepsy and operation for its relief has 
been and is rather unsatisfactory so far as absolute cure is concerned. 
There is, however, no question but that in a considerable number 
of the more aggravated forms, while surgical intervention cannot 
promise a permanent arrest of the epileptic seizures, it may, and does, 
at times, very greatly reduce their frequency and severity. 

The results obtained by operation must depend largely upon the 
amount of damage occasioned by the trauma, and the accompanying 
development of new connective tissue at the seat of injury. 

Though in the traumatic type, as a result of extensive laceration 
of brain tissue, we may not expect an absolute cure, we may in many 
cases, look for a mitigation of the symptoms and hope that by the 
removal of a mass of cicatrical tissue, or elevation of a depressed 
fragment of bone, to not only attentuate the individual epileptic 
seizures, but also increase the period of time between the attacks, and 
perchance, save the patient more serious trouble in later life. 

When we consider the pathological changes which take place in 
the cortical and sub-cortical areas as the result of trauma and lacer- 
ation, it is not surprising that our efforts in the line of surgical 
intervention are not followed by absolute relief of the epilepsy. 

It matters not how carefully and thoroughly the surgeon may 
dissect away the cicatrical tissue which is acting as a focus of irri" 



EXTENSIVE FRACTURE OF SKULL. 3I9 

tation. after his work is done, there must inevitably remain trabeculae 
of connective tissue, projecting from the limits of the operative field 
and permeating between the convulutions, or extending between the 
brain and dura. The adhesions, slight though they may be. will 
most probably continue to act as a source of irritation. 

In cases of brain injury, where there has been more or less lacera- 
tion of the cortical and sub-cortical tissues, the development of 
cicatrical tissue, which, acting as a focus of irritation, eventually 
causes the epileptic seizures, even after the careful removal of such 
tissue, we then have practically the same conditions present which 
existed at the time of injury. 

In some cases the convulsive seizures may make their appearance 
immediately after the injury, and in others at a varying length of 
time thereafter, this variation in time depending upon the period 
required for the cicatrical tissue to attain such proportions that its 
pressure and consequent irritation are sufficient to cause the epileptic 
seizures. 

And since after the removal of the cicatrix, the same conditions 
exist, we may look for an abatement of the seizures only until such 
time as the cicatrical tissue has again formed, when we will once more 
have either an attenuated, or, possibly, a more aggravated form of the 
same conditions as existed prior to operation. 

Operation is, in my opinion, justifiable in all cases where the 
epilepsy can be tracable directly to recent trauma, since while we 
cannot promise a cure, we may at least hold out the hope of partial 
relief. 

The object then in all operations for this condition should be : 
(i) To remove as much as possible of the newly-formed connective 
tissue. (2) To mimimize as far as we are able, the recurrent develop- 
ment of such tissues. 

It is with the object of emphasizing more particularly this second 
point that the following case is reported. 

F. £., male, age, — ; family history, negative ; no previous morbid 
or personal history. 

Present Condition,— On January 11, 1896, the patient, while on the 
sidewalk was struck upon the top of the head by a piece of concrete 
thrown from an upper story. Immediately after the injury, the boy 
was removed \o the hospital in a semi-conscious condition, when 
spoken to sharply could be aroused and would answer questions in 



320 MEDICAL SOCIETY OF NEW JERSEY. 

a prefunctory manner ; would, however, immediately drop into a dull 
apathetic state again. 

Physical Examination. — Well nourished, heart and lungs normal. 
Upon the right side of the head extending over the posterior portion 
of the frontal bone, was a lacerated wound, 5 c. m. in length. 

Palpation over the seat of injury gave evidence of a comminuted 
fracture of considerable extent. Within an hour after receiving the 
injury, the wound was opened, showing the following conditions : 

Three detached fragments of bone, including the entire thickness 
of the skull were exposed. 

The two large fragments in their median line were pressing down 
upon the brain, being at this point depressed at least 2 c. m. below 
the level of the skull. 

The third, but smaller fragment, triangular in shape, was driven 
into the brain tissue. 

The area included by the detached fragments extended over the 
frontal bone, from 6 c. m. anterior to the coronal suture, to 4 c. m. 
posterior to that suture over the parietal bone. 

The width of the area on the coronal suture was 5 c. m., the 
widest part of the cavity was 2 c. m. anterior to the coronal suture, 
where the measurement was nearly 7 c. m. 

The entire length of the cavity was 10 c. m.. and its greatest breadth 
7 c. m., 3 c. m. anterior to the coronal suture, was the base of the 
small triangular fragment. The apex, sharp and cutting, had been 
driven so far into the brain tissue, that the base was just visible above 
the cortex. 

Where the apex of this smaller fragment had been attached to the 
frontal bone, a fracture started which, passing through the orbital 
arch, extended into the orbital plate of the frontal bone. 

Posteriorly, a fracture commenced where the apex of the larger 
triangular piece had been attached to the parietal bone. This fracture 
extended in an antero-posterior direction on a line parallel with the 
inter-parietal suture, and a little to the right of the line. Midway 
between this suture and the squamous suture, the fracture extended 
through the Lambdoidal suture, into the occipital boiie for a distance 
of 4 c. m. 

A third fracture extended directly down from the inner margin of 
the wound into the, temporal fossa. 

When the fragments were elevated, it was found that the dura 



EXTENSIVE FRACTURE OF SKULL. 321 

over this entire area was so badly lacerated that it was necessary to 
remove the remaining shreds. 

The brain tissue throughout the entire area was more or less 
macerated, and in the anterior portion of the wound the sub-cortical 
tissue had been gouged out by the smaller fragment, leaving a cup- 
like depression 4x3c. m., with a depth of at least 2 c. m. The 
macerated tissue was removed and the edges of bone rounded off. 

Owing to the fact of no plate material being at hand the scalp 
wound was partially closed. 

A small drainage tube was introduced into the anterior angle of 
the wound, passing into the cup-like depression in the brain from 
which there was persistent oozing. 

Subsequent ///story.— Januairy 12, during first twenty-four hours 
following operation the pulse varied from 120 to 146. Respiration 
27 to 36, temperature 100 to io2{. 

Patient complained of pain in head, was very restless and mental 
condition dull. 

January 13, temperature I05f. pulse 139, respiration 32. Tingling 
sensation in left arm and hand ; arm and hand cold. Drainage re- 
moved ; slight oozing. 

January 14, temperature 104^. pulse 132, respiration 32. 

At 3 P. M. patient had a convulsion lasting ten minutes. Twitch- 
ing commenced in the left side of face and neck, extending to left arm 
and leg, and then became general. 

During the following nine hours he had eight general convulsive 
seizures lasting from one to twelve minutes. One of these convulsions, 
however, was slight in character and was confined to the muscles of 
the head and neck on the left side. 

January 15, highest temperature 104^^, pulse 127, respiration 26. 

There was continued restlessness accompanied by a very sluggish 
mental condition. 
* One general convulsion lasting two minutes. 

January 16, temperature 102^, pulse 106, respiration 24. 

One slight convulsive seizure, confined to head and neck muscles, 
lasting two minutes. 

Eight general convulsions lasting from two to fifteen minutes. 

Extremely restless and talkative, mental condition clearer. 

At the suggestion of Dr. M. Allen Starr, 30 grs. of urethane were 
administered per rectum. 

81 



322 MEDICAL SOCIETY OF NEW JERSEY. 

January 17, temperature 100}, pulse 112, respiration 20 to 40. 

Eleven general convulsions lasting from five minutes to one hour. 

January 18, temperature loif to 99^, pulse 99 to 135. respiration 24 
to 30. 

Fourteen convulsions lasting from two to twenty-five minutes. 

January 19, temperature 99, pulse iod, respiration 30. 

Three general convulsions lasting from three to fifteen minutes. 

January 20, mental condition much improved, temperature 99? , 
pulse 94. respiration 28. 

No convulsions from this time, and the convalescence was unevent- 
ful. His general health remained good excepting occasional head- 
aches up to the 26th of March, 1898, over two years after the receipt 
of the injury. On this date he had a general convulsive seizure. 

From the 26ih of March to the 4th of December he had twelve 
convulsions. 

On December 14th, 1898, under the direction of Dr. M. Allen Starr, 
the scalp was opened and the following conditions found. 

The scalp was adherent to a mass of dense connective tissue, which 
covered the entire area from which the bone had been removed. 

This cicatricial tissue was adherent to the edges of the bone, 
extended for a distance of 2 c. m. beyond the edges of the bone on 
the upper surface of the skull. It was closely adherent and incor- 
porated with cortex over the entire area, and completely filled the 
cup-like depression in the anterior portion of the wound. This 
cicatricial mass was excised, the plug of tissue in the depression care- 
fully removed, and the tissue dissected from the edges of the bone. 

A celluloid plate 2 c. m. larger than the exposed area was placed 
directly upon the bone and covered by the periosteum and other 
tissues of the scalp. 

A small drainage tube was carried out from the front portion of 
the wound to give exit to the blood which oozed slightly from the 
•exposed brain. 

Drainage tube removed on third day. Patient left hospital on tenth 
•day. 

Wound healed by primary union. Pulsation distinctly perceptible 
tover the plate. 

January 8, 1899, the patient had a general convulsive seizure, 
smother on January 13, and still another on January 27. 

At this time there was a bulging at the posterior part of the plate, 
;ihd pressure over this area was accompanied with pain. 



EXTENSIVE FRACTURE OF SKULL. 323 

On February 2 the scalp was again opened. The plate had shifted 
a trifle toward the median line. Under the posterior portion of the 
plate was a mass of exudate pressing the plate upward. When the 
plate was removed there was found to be a mass of cicatricial tissue, 
stretching across the entire field, attached to the skull on either side 
of the cavity, and adherent to the brain. 

This cicatricial tissue was removed with the connective tissue which 
had again filled up the depression in the anterior portion of the 
wound, after a new celluloid plate was patterned shape of the cavity- 
but I c. m. larger. 

A small cut was then made in the plate on each side of the two 
ends somewhat in the form of a Greek cross. These cuts permitted 
the plate to be partly folded and thus diminish its circumference. 
The plate was then placed beneath the skull rather than on top of it, 
as is usually done. 

The newly formed connective tissue had been found extending 
from the margins of the bone to the brain tissue, and the cortex was 
intimately adherent throughout the entire circumference of the cavity 
to its bony margins, consequently even from the pulsation of the 
meninges there must have been more or less irritation as the result of 
the fixation of the brain at these points by bands of connective tissue 
holding it fast to the edges of the bone. The more extensive and 
dense these adhesions become the more pronounced must have been 
the irritation. It was with the hope, therefore, of diminishing the 
area from which adhesions could extend to the cortex that the plate 
was introduced under, rather than above, the skull. 

Of course no surgical procedure could prevent the cicatricial tissue 
from again filling up the depression in the front of the wound, but the 
subsequent history of the case would seem to show that the introduc- 
tion of the plate beneath the skull in such cases is worthy of consid- 
eration. 

Subsequent History. ^Eleven days after the operation the patient had 
fifteen convulsions in twenty-four hours. On March 4th, two convul- 
sions in twenty-four hours. On April loth, 1899, to August 20th, 
1930, the boy was entirely free from convulsions. 

From August 20th, 1900. to August 20th, 1901, he had one con- 
vulsion. 

From August 20th, i90i,to April 4th, 1902, one convulsion. 

From April 4th to the present time he has had fourteen. 



324 medical society of new jersey. 

Excision of the Scapula. 

BY EDWIN FIELD, M. D., RED BANK, N. J. 

In presenting this paper, I simply wish to call attention to the 
operation of complete excision of the scapula, and to present two 
cases ; one of complete and one of partial excision of that bone. 

This operation has been performed upon patients varying in age 
from fifteen months to seventy years. It was first performed by 
Cunimings, in 1808, who removed a portion of the bone. Lister, in 
1 8 19, removed the upper Iwo-thirds without sacrificing the arm. 
Gartini Bey, the Turkish surgeon, in 1830, amputated the arm and 
then removed the scapula entire. In a majority of the operations, 
the glenoid cavity was left. Musey, of United States, excised the 
whole scapula and clavicle, in 1837, for osteo-sarcoma. Gross states 
that this patient was in excellent health fifteen years after. In 1838^ 
McClellan removed clavicle and scapula, but patient died. Gross 
removed the bone in 1850, sawing through the neck. Langenbeck.. 
in 1855, first removed the scapula and three inches of the clavicle, 
preserving the arm. In 1869, Syme went a step further, disarticu- 
lating the bone and removing the scapula with all of its processes, 
leaving the arm untouched. Since then the operation has been 
• performed several times successfully, leaving the arm untouched. 
Statistics and history of excision of the scapula were made the sub- 
ject of special investigation by Dr. Stephen Rogers, of New York, 
and Professor Adelman, of Berlin, who failed, however, to make any 
distinction between complete and partial excision and operations in 
which the upper extremity has been removed at the same time, and 
also amputation above the shoulder. Ashurst in his surgery in 1884, 
gives a table of forty-two cases of complete excision, the arm being 
preserved. Of these, thirty-two recovered, eight died and two result 
unknown, making a mortality pf twenty per cent. In fourteen 
cases subsequent to amputation, but not at the same operation, 
eleven recovered and three died, a mortality of twenty-one per cent* 
In one hundred and ninety- live cases reported by Professor Adelman, 
four of which were amputations above the shoulder and one of 
complete excision and should be deducted, leaving one hundred and 
ninety ; adding four from his table of complete excision and twelve 
additional cases reported by others, making two hundred and six 
cases of partial excision, giving a mortality of twenty-four per cent. ; 



EXCISION OF THE SCAPULA. 325 

the mortality of complete excision being less than that of partial. 

Sajou's Annual reports a case of successful removal of the scapula 
for osteo-periostitis following typhoid fever, with a later regenera- 
tion of bone and complete recovery of full use of the shoulder. As 
the result of his investigation, be places the mortality of complete 
excision at twenty per cent. Southam, Perrier and McClellan report 
cases operated upon in 1889, and Pasaeles, a case in 1876; Wm. B. 
Hopkins, in June, 1703. Annals of Surgery^ reports a case of 
excision with recovery of the use of the arm, and also reports thirty-two 
cases operated upon between 1 897-1 901, and twenty nine cases prior 
to 1897. 

My case of complete excision was a boy fourteen years old. who, 
three months previous to operation, was thrown in wrestling, upon 
his back ; the contusion was followed by an abscess three weeks after 
the injury, which opened above and below the spinous process, the 
abscess continuing to discharge. The physician in attendance. Dr. 
Ingling, sent a specimen to the State Laboratory ; the report returned 
no tubercular bacteria. Upon admission to the Monmouth Memorial 
Hospital, three months after injury, two sinuses were found leading 
down to the bone, one above and one below the spine. Connecting 
them with an incision the scapula was found necrosed, honey-combed, 
with opening filled with pus. The entire scapula was removed ; the 
claviculo-acromial articulation was destroyed, but the clavicle was 
not involved. The bone was easily removed with very little hemor- 
rhage. The patient made a good recovery, the functional use of the 
arm returning in three months, and has been gradually improving. 
The patient gave no tubercular history nor were bacteria found at any 
time. 

Case 2, — A boy ten years old injured the shoulder learning to ride 
a bicycle. The contusion was followed by an abscess, which con- 
tinued to discharge for five months. Upon admission to the 
Mjnmouth Memorial Hospital an exploration revealed necrosis of the 
scapula, a condition very similar to the preceding case. Four-fifths 
of the bone was removed, sawing through the spine and leaving the 
glenoid cavity. The patient made an excellent recovery, functional 
use of the arm following in two months. This patient gave no 
tubercular history nor were bacteria found at any time. 

(Dr. Field had these two boys present for examination, and also 
exhibited the bones which had been removed.) 



326 MEDICAL SOCIETY OF NEW JERShY. 

Vaccination— How Long Does It Protect? How 

Shall It Be Controlled ? What Are Its 

Sanitary And Commercial Aspects? 

BY W. UPDVKE SELOVER. M. D., RAHWAY, N. J. 

When notified by the Business Committee that I had been desig- 
nated to open this discussion, the subject being given in a single 
word, viz : " Vaccination," I confess I was at a loss to know how to 
present such a familiar and sim]>le little operation, although it is, never- 
theless, important, and not insignificant in its results, and I am sure 
every available means should be used to induce or compel a submission 
to it for the individual and general good, as it is. I doubt not, the best 
known preventive of smallpox. Every one ought to be vaccinated, 
and revaccinated. and every physician should exercise due care as to 
the technique of this, in itself, simple procedure. And yet, from its 
mere simplicity, I apprehend physicians are often careless in its 
execution, and, therefore, often have not as successful results as 
might be desired. Because smallpox spares no age, and is especially 
fatal in infantile life, I would advocate early primary vaccination, 
at latest by the sixth month, in the case of strong, healthy infants. 

If the child be delicate, and in the absence of an epidemic of 
smallpox, it would probably be well to allow a delay of several 
months. If smallpox should attack any member of a family, or 
should appear in the immediate vicinity, the infant should be vaccin- 
ated whatever its condition, barring acute and serious illness, and the 
other members of the household as well. 

Bovine lymph will often produce more severe local effects than 
humanized does, for which reason some physicians prefer humanized 
lymph for delicate children, without fear of danger of the transmission 
of disease through the lymph, supporting their theory by the assertion 
of some recognized authorities that it is impossible to convey disease 
in the use of humanized virus, with, perhaps, the single exception of 
syphilis, and even then, they claim the danger is insignificant in the 
presence of due carefulness. The lymph should be fresh, and such as 
has been taken from a sound and perfectly formed vesicle, about the 
eighth day, care being observed not to have an admixture of blood 
with the lymph. 

The region about the part to be scarified should be thoroughly 
cleaned in any way the physician may elect, and dried by a rather 



VACCINATION. 327 

vigorous rubbing, thereby rendering the part somewhat hypersemic, 
and. therefore, more prone to absorption. It might seem to go 
without saying, the instrument should be scrupulously clean, having 
been sterilized before using. If, as the vesicles approach maturity, 
local irritation from any cause should become excessive, sterilized lint 
saturated with lead lotion, frequently applied, will probably afford 
relief. 

The part should be kept clean and protected from friction, mostly 
for the sake of avoiding the addition of any traumatic effect to the 
inflammatory symptoms. 

In the regular and uninterrupted course of primary vaccination we 
will find the first week occupied with the formation and maturation 
of the vesicle ; during the second week we have the appearance and 
decline of the areola and the formation of a scab, and at the end of 
the third week the scab will separate, leaving the characteristic 
cicatrix. 

The slight constitutional symptoms that are usually concomitant 
with these local phenomena are a rise of temperature, commencing 
about the fourth day, increasing during the areolar stage, sometimes 
accompanied by disorder of the stomach and bowels, subsiding with 
the fading of the areola, and about this time we may find indurated 
and painful axillary glands. 

Just here, in some- cases we have the appearance of a vaccine 
roseola, vaccine lichen, or vesicles, although the vesicles differ from 
true vaccine vesicles in that they have no central depression. These 
eruptions usually disappear in about a week without treatment. 

In order to be able to certify to a successful and protective vacci- 
nation, it is necessary that the successive phenomena of the different 
stages of vaccination shall have conformed to the normal type— at 
least very closely. 

We will sometimes meet with cases where the development of the 
vesicles will J>e either retarded or accelerated by two or three days, 
but such a slight variation from the normal course will not invalidate 
the protective effect, providing the phenomena, in other respects, be 
regular and typical. We should, however, be on the alert for a spuri- 
ous form of vaccination that is not likely to be protective, distinguished 
by marked irregularity in its character and course. 

Papules and sickly looking vesicles may appear and disappear too 
early, attended with much local itching, become conoid, instead of flat 



328 MEDICAL SOCIETY OF NEW JERSEY. 

with a central depression, and contain a thick, opaque matter in place 
of the usual clear lymph, with an illy defined, irregularly shaped 
areola, a small, thin crust, all disappearing, probably, in about a week. 

We sometimes have the ordinary course of a successful vaccination 
complicated from extraneous sources, as friction of the clothing, 
various injuries, uncleanliness, etc., developing ulcerating sores, and, 
perhaps, suppurating axillary glands, and occasionally the superven- 
tion of erysipelas, which are mostly avoidable accidents, following 
somebody's carelessness. 

The length of time that a successful primary vaccination will be 
protective will vary very widely in different cases, from a few years to 
a lifetime. I presume the most of us have known instances of aged 
people who never could be successfully revaccinated, their early 
vaccination continuing protective through life. 

In a hospital experience I had charge of two well-filled smallpox 
wards for some time, without the appearance of any symptom of the 
disease, never having been vaccinated successfully since infancy. If 
susceptibility to revaccination is coincident with susceptibility to 
smallpox. I see no reason why the reverse statement should not be 
true. I believe, however, in the vast majority of cases, the persistent 
effects of a primary vaccination will be exhausted in a comparatively 
few years — probably in eight or ten — and, according to some author- 
ities, the immunity is exhausted most rapidly during the actively 
metabolic period of youth, and so most persons can be successfully 
revaccinated at or before puberty, and probably several times during 
adult life. Certain diseases are said to jeopardize the immunity 
afforded by vaccination. Revaccination seems to vie with the 
primary in its protective effect. 

It is beyond the scope of my conception to see how any unpreju- 
diced person can decry the usefulness of the measure, for. to my 
mind, it would seem that there could no longer be any doubt of its 
efficacy and of its eminently practical value. If there is any reliance to 
be placed on statistics, it can easily be thereby proven that in countries 
where it has been carried out persistently, and, to a degree, systemat- 
ically followed, the frequency and extent of smallpox epidemics have 
been perceptibly lessened. 

I have not sufficient time at my command to quote from statistics 
that I have taken pains to look up from the literature at hand, but 
will simply say that they prove, beyond any cavil, that where vaccina- 



VACCINATION. 329 

tion is practiced regulariy in infancy, infantile mortality from smallpox 
has been reduced to almost nothing; and where revaccination has 
been performed regularly, thoroughly and universally through adult 
life, epidemics of the disease have been relegated to " ancient history/' 
With such cold facts facing our friends — the enemies of the measure — 
tt would seem that they must acknowledge they have no happy 
vantage ground to afford them actual standing. 

I have endeavored to trace the efforts of the opponents of vaccina- 
tion, with the idea of discovering, if possible, the soundness of their 
objections, but have been able to find only flimsy and unreliable 
arguments in opposition to the procedure. 

They have failed, by all sorts of sophistry, to prove its uselessness, 
while the experience of all unprejudiced physicians furnish unanswered 
and unanswerable arguments proving the fallacy of their reasoning. 

They claim all sorts of injurious effects as a direct result, without 
presenting the slightest approach to convincing proof backed up by 
clinical experience, or otherwise, to substantiate their claim. 

True, we all admit there may be temporary illness, with fever, 
during certain stages of the process, but if caution be observed in the 
little operation, and if it be not performed on children too young, 
feeble or sickly, during the period of dentition, or at unfavorable sea- 
sons of the year, any permanently bad results will be extremely rare, 
so rare that in comparison with the positive advantages that obtain, 
they will fade into such insignificance as to be utterly unworthy of 
consideration, and our opponents are truly welcome to the outcome 
of the comparison. 

Far be it from us to allow apprehension of any bad result of 
extremely rare occurrence to be offered as a reason for abandoning 
a practice that is but waiting to see the finish of such a loathsome 
disease as smallpox. 

Because long experience has shown, beyond the shadow of a doubt, 
that vaccination is an all-powerful weapon against smallpox, and 
since instruction, persuasion and admonition fall very far short of 
attaining the desired end, it would seem that nothing short of legal 
compulsory vaccination can accomplish the possibility of practically 
eradicating the direful scourge. And in the matter of legal compul- 
sion we can discern no great injustice, since the preposterous pretext 
that the measure is injurious is altogether untenable, as set forth by 
abundant proof that the misconceived dangers of vaccination are 



330 MEDICAL SOCIETY OF NEW JERSEY. 

wholly imaginary, and any harm that could possibly result can cer- 
tainly be avoided by caution born of experience. 

DISCUSSION. 

Dr. George E.. Reading, of Woodbury.— The first part of this 
discussion is with regard to the length of time vaccination affords 
protection. If you vaccinate a patient, it is extremely important to 
know within reasonable limits, how long the protection thus afforded 
will last. It is a question which cannot be determined absolutely, 
because, just as the immunity from disease itself varies in different 
individuals, so the protection afforded by vaccination varies, but, as 
a general rule, it may be said that the immunity is not so long in 
young children as in adults, and that, therefore, a child having been 
vaccinated when small, should again be vaccinated at or about 
adolescence. In the vast majority of cases, I believe this will pro- 
tect during life ; nevertheless, it is much safer to revaccinate if an 
individual is directly exposed to smallpox. Some cases will "take" 
after such vaccination, just as a person may take smallpox three 
times, although this is very exceptional. 

The question of how it shall be controlled- that is. the enforce- 
ment of vaccination should be controlled, is a difficult one. At the 
present time, the only general way is by forbidding the admission of 
children into the schools until they have been vaccinated. Even this 
is not effectual, because the law says "duly vaccinated." not success- 
fully vaccinated. This is a matter which should be brought to the 
attention of our legislature, and the law made more effective in some 
way. There is no need, however, for making the laws more effective 
unless the present laws are enforced so far as possible. We had a 
census taken of the school children recently, and found that 70 per 
cent, of the school children had never been vaccinated. We should 
urge upon our boards of health and the school authorities the absolute 
enforcement at least, of the present statute, and then try, if possible, 
to make the law more stringent, The existence of smallpox to-day is 
a disgrace to civilization, because it can be stamped out. 



pneumonia and pleurisy. 33 1 

Pneumonia and Pleurisy in Early Life 
Simulating Appendicitis. 

BY J. p. CROZER GRIFFITH, M. D. 

CLINICAL PROFESSOR OF THE DISEASES OF CHILDREN IN THE 
UNIVERSITY OF PENNSYLVANIA. 

Quite recently attention has been called in several quarters to the 
simulation of appendicitis, or peritonitis, by pulmonary processes, 
especially pneumonia and pleurisy. The fact that this simulation 
often occurred, has long been known, but is quite commonly 
overlooked, and, inasmuch as the diagnosis is certainly at times ex- 
tremely difficult, and since operation for appendicitis has even been 
performed when only pneumonia was present, I have thought it of 
interest to report a few cases of this nature, and to quote those of 
like sort which have come to my notice in medical literature, limiting 
myself entirely, at least, in detailing cases, to the occurrence of the 
condition in early life. It is, indeed, at this time, that the confusion 
is most likely to happen, although some cases developing later in 
life, are also met with in literature. 

Of the cases reported here, the first two have already been detailed 
by me in previous publications, the others have not. Two of them 
occurred in the private practice of Dr. H. R. Wharton, and the notes 
of them were kindly given me by him. 

Cas£ /. — Mary Agnes McConnell, aged 8 years, admitted to 
St. Agnes' Hospital, October 27. 1893, suffering from chorea. On 
November 1 5, she became suddenly ill with very severe abdominal 
pain and tenderness, and with such a marked appearance of some 
grave condition, that the resident physician feared arsenical poisoning. 
The temperature was elevated, the pulse 170 and the respiration 
from 80 to 90, and very shallow. There was severe abdominal pain 
and tenderness. The details of the condition as reported to me made 
me suspect peritonitis. I examined her on November 16, and found 
that the abdomen was very much distended and tender ; there was 
abdominal pain ; the expression of the face was anxious, and the legs 
were held constantly drawn up in bed. The temperature had risen 
to 102. The rapidity of respiration, combined with its shallowness, 
appeared to be dependent upon peritonitis, and several physicians 
who saw her with me, agreed that this was the undoubted diagnosis. 
There was no cough whatever, but a physical examination of the 



332 MEDICAL SOCIETY OF NEW JERSEY. 

^ungs was made, however, as a routine, and to our surprise, the upper 
part of the right lung was found to exhibit pneumonic consolidation. 
By the evening of the next day, all abdominal symptoms had 
•disappeared. 

Case 2, — Simon L., 4 years old, admitted to the Children's Hospi- 
tal, January 19, 1899. He was taken acutely ill on the 14th with 
obstinate constipation, abdominal pain and distension, and tenderness 
in the right iliac fossa. Cough was not noted, if present. The 
physician who saw him had already made the diagnosis of appendi- 
•citis, but the child was admitted to the medical ward, inasmuch as 
operation had been forbidden by the parents. 

On examination on the 20th. the child was found evidently in much 
pain ; had an anxious expression of face ; shallow respiration of from 
about 30 to over 40 per minute, and held the legs drawn up most of 
the time. The abdomen was not distended, but was tender in the 
right iliac region, and everywhere rigid enough to make palpation 
-difficult. As- far as it was possible to determine, no tumor was 
present. The temperature varied from 103 to 105. Except for a 
few coarse rales, nothing could be detected on examining the lungs 
in front. Owing to the great distress of the child, and because the 
-diagnosis of appendicitis seemed so positive, the posterior part of the 
•chest was not examined on this date. On the next day. the 21st, 
pneumonic consolidation of the left lung was easily found. The 
-abdominal symptoms remained unchanged. On the 22d, all abdomi- 
nal symptoms had disappeared. Crisis occurred on the 24th. 

In neither of these cases was there apparently any reason to 
-suspect anything but an appendicitis, or a peritonitis secondary to 
this. In the light of later experience, however, one sees that certain 
suspicious symptoms were present. The height of the fever in the 
second case, and, especially, the rapidity of the respiration, ought to 
have rendered me more cautious in diagnosis. It is certain that in 
the second case, the child would have been at once transferred to 
the surgical ward for operation, if this had been permitted by the 
relations, and that operation might have been done if a more careful 
examination had not been made. 

Case J. — Myer M., 6J years old, admitted to the surgical ward of 
the Children's Hospital, March 17, 1900, supposed to be suffering 
^rom appendicitis and pneumonia, having been ill for two days. 
The exact nature of the symptoms previous to admission is not re- 



PNEUMONIA AND PLEURISY. 333- 

corded. Examination on the i8th showed the abdominal walls tense- 
and everywhere tender, especially on the right side, where rigidity 
and tenderness were especially marked. The respiration was from 
45 to 55; the pulse over 130, and the temperature from 103 to 104. 
Breathing appeared to be painful. Examination of the lungs- 
showed slight impairment of resonance over the upper lobe of the 
left lung in front, and of the lower lobe behind, yet nothing very 
characteristic or diagnostically positive was discovered. On the 
19th, the temperature was 103, the respiration from 40 to 50. The 
abdomen was distended and tympanitic, and the epigastrium and the 
region of the appendix was tender on pressure, and the left iliac 
region to a less extent. Abdominal pain was constantly present, but 
less than on the preceding day. The expression of face was that 
of pain ; herpes was present on the lips ; the chest was tender every- 
where on percussion. No change in the pulmonary condition is 
recorded. 

On the 2oth the child was much brighter. The abdominal, 
symptoms persisted, and physicial signs of pneumonia of the right 
lung^were very positive. 

By March 21st, all abdominal symptoms had disappeared. There 
were now, however, evidences of some degree of pneumonia in both 
lungs and the temperature was falling. By the 23d it was normaL 

This case was puzzling ; not so much to determine the presence 
of pneumonia, which was suspected before admission, but because 
it was considered that the disease was occurring conjointly with 
appendicitis. Operation was considered when he first entered the 
surgical ward. I was asked to see him on the 19th or 20th and 
determined positively the presence of pneumonia. Experience with 
the earlier cases made be believe that the abdominal symptoms were 
referred entirely from the lungs. The later course of the disease- 
appeared to render this unquestionable. 

Case 4. — K. S., male, 7 years old, admitted to the Children's 
Hospital November 2d, 1899, under the care of Dr. H. R. Wharton. 
He had had at various times, more or less abdominal pain, but 
never severe until three weeks previously, when he had a typical 
attack of appendicitis, as regarded by the physician in charge of 
him. The symptoms, at the time, consisted of severe pain and. 
tenderness in the right side of the abdomen— especially at McBurney's 
point— fever, constipation and restlessness. He recovered partially,. 



334 MEDICAL SOCIETY OF NEW JERSEY. 

but the tenderness is said to have remained. On October 30, three 
days before admission, he had had a recurrence of the pain, and again 
on November i. There had been no vomiting at any time. Fiever 
was said to have persisted since the attack, three weeks before. On 
admission, the temperature was 103; respiration varying from 32 to 
80 and the pulse from 132 to 196. The abdomen was distended, 
tender and somewhat rigid. These symptoms were especially 
marked on the right side. There was also bronchial respiration 
over the entire lower lobe of the left lung. The attending physician 
had in person taken the child to the hospital in order to have an 
operation for appendicitis performed. On refusal by the surgeon to 
do this, he became very angry, disputed the diagnosis of pneumonia, 
said he had brought the child for the sake of operation solely, and 
wojld remDve him if it were not performed, and used other language 
more forceful than polite. He was requested to go to the ward to 
examine the patient himself again. This he did, and then apologized. 

By the evening of the same day the temperature had fallen to 99.2. 
No further abdominal symptoms were recorded, and the pneumonic 
consolidation rapidly disappeared. 

This case hardly needs comment. It shows how absolutely one 
may be deceived by the pseudo-appendicular symptoms, unless care- 
ful study of other parts of the body is made. 

Case J. — Walter E. C, 1 1 years old, admitted to the Children's 
Hospital to the service of Dr. Wharton, on November 25, 1901. 
He was taken ill, November 22, with vomiting, headache and pain 
in the abdomen. The latter soon became localized at McBurney's 
point and continued until the 24th, being so severe that he lay awake 
crying during the night of the 23d. There was fever, and the bowels 
were constipated. Two well-known physicians of Philadelphia, one 
of them a surgeon, had seen him and made the diagnosis of appen- 
dicitis. On examination in the hospital, the temperature ranged from 
103 to 104, or more ; the respiration from 40 to 55, and the pulse 
from 95 to 130. There were no certain symptoms of appendicitis 
discoverable, but a well-developed croupous pneumonia of the base 
of the right lung was found, and he was transferred to the medical 
ward, to the service of Dr. F. A. Packard. By this time the principal 
pain complained of had shifted to the right shoulder. There was also 
pain in the right side and in the epigastrium, but none had been 
present in the right iliac region since the evening of the 24th. The 



PNEUMONIA AND PLEURISY. 335 

epigastric pain persisted until the 27th, when the temperature fell by 
crisis. After this date the pain grew less. 

By the time the child reached the hospital the change in the 
locality of the pain had removed some of the difficulty in diagnosis. 
It is to be noted that the physical signs of pneumonia were developed 
at the time of entrance. 

The next case is not so characteristic an example of the likeness 
of appendicular pneumonia to appendicitis. The child was admitted, 
it is true, for appendicitis, but this diagnosis was promptly corrected. 

Case 6. — Elmer W., 8 years old, admitted to the Children's Hos- 
pital. May 8, 1900. in the service of Dr. F. A. Packard. He had 
awakened in the early morning of May 4th with fever and vomiting. 
Constipation, fever and cough continued from this date. For two 
days there had been pain in the right side. Examination showed the 
eyes sunken, the knees drawn up. the abdomen distended, but not 
tender, frequent cough, temperature 103, respiration from 35 to 45. 
pulse from 140 to 170, pain in the right side of the thorax and 
physical signs of pneumonic consolidation of the right lung. The 
temperature fell by crisis on the 9th. 

The only suspicious symptoms in this case were the sunken eyes, 
distended abdomen and the drawing up of the legs, pointing towards 
abdominal disease. The diagnosis, however, was unattended by 
difficulty. 

The following two cases were seen by Dr. H. R. Wharton in his 
private practice, and kindly submitted to me by him. 

Cas€ 7, — Boy 15 years old, seen in consultation, a diagnosis of 
appendicitis having been made, and Dr. Wharton having been called 
for the purpose of operating. There was pain in the right iliac 
fossa and continued high temperature. Examination showed some 
rigidity of the right rectus muscle, and much tenderness on pressure 
in the region of the appendix. Further examination, however, showed 
consolidation of the right lung. The presence of appendicitis was 
excluded. The abdominal symptoms promptly disappeared, and the 
child passed through an ordinary case of croupous pneumonia, 
terminating in recovery. 

Case 8. — Boy 8 years old, who for nearly a week had had severe 
abdominal pain, particularly in the right iliac fossa. Dr. Wharton 
was called in consultation upon the sixth day of the disease, the 
diagnosis of appendicitis having been made and operation being 



336 MEDICAL SOCIETY OF NEW JERSEY. 

desired. The symptoms pointed to disease of the appendix, but 
it was noticed that the respiration was quite rapid. Examination of 
the chest revealed the presence of pleural effusion. This later became 
purulent and ruptured into a bronchus, the symptoms of appendicitis, 
meantime, having disappeared. Resection of the rib and drainage 
of the empyema were required later. Recovery followed. 

Cases occurring in children and reported in recent literature have 
been multiplying so rapidly, that I can give but the briefest synopsis 
of those which have come to my notice. There is no doubt that a 
. careful search of the older literature would show more extended 
references to the condition, with illustrative cases, than is ordinarily 
supposed. 

I. Fenwick, {Lancet, 1893, Vol. II, p. 79), reports one case. 

Boy of 13 years was suddenly attacked with severe abdominal 
pain, vomiting and faintness after a long walk. In a few hours be- 
came delirious. On the next day he was found to have fever, with 
a temperature of from 102 to 106, pulse 36, herpes on the lips, rapid 
respiration, occasional short, dry cough, considerable abdominal pain 
and tenderness, and rigidity, especially in the umbilical and left 
lumbar regions. The legs were drawn up in bed. Nothing abnormal 
was discovered in the chest. Vomiting continued troublesome, and 
the delirium gave place to stupor. On the third day all the symptoms 
improved greatly, and dullness at the left base behind, with impair- 
ment of the respiratory murmur, was discovered. Improvement 
continued, and the . abdominal tenderness disappeared to a large 
extent. The temperature reached normal in three days. Later, 
pleural effusion was found. 

Four other cases were reported, all in adults. In all, the symptoms 
pointed distinctly toward inflammation in the abdomen, but the 
disease appeared to be diaphragmatic pleurisy. In two of the cases, 
pleural effusion developed. In another, autopsy showed extensive 
involvement of the diaphragmatic pleura. 

II. Morse {Annals of Gyncec, and Pediat., 1897), reports three 
cases. 

(a) Boy of 7 years. A blow in the abdomen was followed soon 
by faintness, nausea and vomiting. The next day nausea, headache, 
pain in the abdomen, constipation, slight fever and slight abdominal 
distension and tenderness developed. Examination of the lungs 
was negative. The abdominal pain and tenderness increased^ 



PNEUMONIA AND PLEURISY. 337 

especially in the right iliac region, with slight dullness there. 
Respiration and pulse were rapid, the tentperature was high, and 
there was a constant hacking cough. Appendicitis was suspected. 
On the fourth day of the attack physical signs of pneumonia were 
well marked over the right lower lobe, the abdominal symptoms 
disappearing. 

{6) Boy of eight years had headache, slight abdominal distension 
and tenderness, constipation, rapid respiration and a temperature of 
105. Nothing was found in the lungs. Vomiting occurred in the 
night, and on the next day there was a slight cough and the abdomen 
was much distended and tender, especially on the right side. The 
examination of the lungs was still negative. Up to the sixth day of 
the disease the condition was the same. On this date the respiration 
became more rapid and painful, the cough increased, pain in the chest 
developed, physical signs of pneumonia of the right lower and middle 
lobes were found, and all abdominal signs disappeared. 

(c) Girl of three years, taken ill suddenly with fever and abdominal 
pain. On the next day she vomited, had continued abdominal pain, 
but no cough. Seen thirty-six hours after the onset, the temperature 
was found to be 39.9 C, the respiration and pulse rapid, but nothing 
abnormal was found in the lungs. On the fourth day of the attack 
solidification of the left lower lobe was discovered. 

Morse considers the occurrence of pneumonia with initial abdomi- 
nal symptoms not uncommon. He says that the abdomen has been 
twice opened for appendicitis in children within the past few years 
by prominent surgeons in Boston, when the trouble was really 
pneumonia. He believes that the sudden onset with high fever and 
rapid respiration should suggest pneumonia, even in the presence of 
abdominal symptoms and the absence of cough. 

III. Guinon (Buii, de la Soc. de Ped, de Paris, ' 901, p. 77) reports 
one case. Girl of thirteen and one-half years, had had fever, head- 
ache and pain in the right side of the chest for about eight days 
before admission to the hospital. On the day after admission she 
exhibited an anxious expression of face, sunken eyes, pain in the 
right side of the abdomen with tenderness at McBurney's point, little 
cough, no dyspnoea, no physical signs in the chest. The case was 
supposed to be appendicitis, but firm pressure with the flat of the 
hand showed no tenderness and no increased resistance, although 
sudden pressure with the finger-tip gave pain. For two days more 

S8 



338 MEDICAL SOCIETY OF NEW JERSEY. 

the diagnosis remained uncertain, pain persisted and positive signs of 
pneumonia were found at the right apex. The temperature fell by 
crisis in the evening, and on the next day the abdominal symptoms 
disappeared and the physical signs of pneumonia throughout the 
right lung were positive. 

IV. Massalongo {Riforma Medica,\<^\, 711) says that he has 
observed four cases in children of from five to twelve years in which 
pneumonia simulated appendicitis. He recalls five cases in which 
operation for appendicitis was done and the organ found entirely 
sound, the real disease being pneumonia. 

He calls the condition pseudo-arppendicular pneumonia, and dwells 
on the difficulty in diagnosis which lasts until after the third or fourth 
day, by which time the abdominal symptoms lessen and the physical 
signs of pneumonia are liable to be detected. The pain is projected 
by way of the sympathetic and the spinal cord to the twelfth inter- 
costal nerve. 

V. Richardson {Boston Medical and Surgical Journal^ 1901, 
April 17, p. 399) reports five cases in children. 

{a) Boy of six years, had for three days right lumbar pain, per- 
sistent vomiting and headache. On the third day a tense abdomen 
and right iliac tenderness were found, and the temperature was 104.5. 
On the fifth day the respiration was 40, the abdomen distended, the 
legs drawn up, the eyes sunken, and the general appearance bad. A 
diagnosis of appendicitis was made. On the sixth day the appendix 
was removed, but nothing of moment was found. Dyspnoea and 
cough then developed, followed by empyema. He says the case was 
one of pleurisy simulating appendicitis. 

{b) Boy four years old. On the second day there was abdominal 
pain, cough, and a temperature of loi, and appendicitis was thought 
of. On the third day pneumonia of the left lung was suspected. 
There was much pain in the epigastrium and in the left shoulder ; the 
respiration was 42 and the temperature 105. On the fifth day symp- 
toms suggestive of pneumonia, but not positive, were found. On the 
sixth day there was acute abdominal pain, constant in the region of 
the appendix. The abdomen was distended but not hard, with dull- 
ness in the right iliac region. The pain lasted several days and then 
disappeared. The final diagnosis was pneumonia of the left lung. 

{c) Girl, five years old, suddenly developed abdominal pain, which 
continued on the next day chiefly in the right iliac fossa, with a tem- 



PNEUMONIA AND PLEURISY. 339 

perature of 104 4. Fever and pain diminished after ten days, but a 
little tenderness renoained somewhat longer. About a week later 
pain and fever returned, appendicitis was thought of, and Dr. Rich- 
ardson was summoned to operate. He found pneumonia of the right 
lung and tenderness along the course of the lower intercostal nerves. 
There had been no suspicion of the existence of pneumonia. 

(d) Boy of four years was attacked by cough, restlessness, fever, 
accelerated respiration, constipation and slight distension of abdomen. 
Nothing abnormal was found in the lungs. The condition continued, 
and on the eighth day the child developed abdominal pain, great ten- 
derness over McBurney's point, and rapid respiration. Dr. Richard- 
son was called in on the ninth day on account of suspected appendi- 
citis. He found vomiting, severe abdominal pain, tenderness in the 
right iliac fossa, distension, but no rigidity. Operation was deferred. 
On the tenth day pneumonia was discovered, and the abdominal 
symptoms disappeared rapidly. 

{e) Girl of seven years had had abdominal pain, fever, rapid 
respiration aud cough for two days. On the third day the cough 
ceased, and on the fourth day severe abdominal pain developed, 
which disappeared but left abdominal tenderness. Appendicitis and 
peritonitis were suspected. Examination on the fifth day showed 
tenderness over the appendix, no abdominal rigidity, a temperature of 
104 to 105, and respiration of 40. The diagnosis was very uncertain, 
and operation was delayed. Signs of pneumonia were found the 
same evening. 

Richardson also describes a case in an adult male brought to the 
hospital for abdominal operation. In a few days pneumonia was 
found. 

He says that in acute right-sided diseases of the thorax the symp- 
toms of appendicitis may be so simulated that a surgeon may be 
completely deceived. It was only his experience in the first case 
which kept him from operation in the others. The high temperature 
and rapid respiration are the most assuring symptoms. 

VI. Hampeln {Zettschr, /. Klin. Med., 1902, 448) reports five 
cases, all in young adults, and all showing the most typical symptoms 
of sudden acute abdominal conditions. Collapse was present in some. 
In all the symptoms simulated peritonitis or intestinal occlusion. 

VII. Satullo {Gaz, degli Ospedali, 1902, XXIII., 757) reports three 
cases, all in adults. In all there was severe pain in the right iliac 



340 MEDICAL SOCIETY OF NEW JERSEY. 

fossa with an exceptionally high temperature, running from 43** to 44^ 
C. at the maximum. It was only after several days of observation 
that the diagnosis of pneumonia was possible. Satullo designates the 
condition appendicular pneumonia, and says that acute pneumonia 
may begin with symptoms of acute appendicitis and the diagnosis be 
uncertain for three or four days. Pain at McBurney's point is reflex, 
and is transmitted along the anterior branches of the twelfth inter- 
costal nerve. 

Vlll. Barnard {Transac. Clin. Soc, Land, 1902. XXXV.. 122) 
reports two cases tn children. 

{a) Girl of eleven years had had some abdominal pain with vomiting 
during three days. When seen on the fourth day the temperature 
was 103.6, the respiration 40 and painful ; there was tenderness in the 
right iliac fossa, abdominal rigidity, and constipatfon. Four days 
after admission obscure signs of pneumonia of the right base were 
found. The temperature fell by crisis this day, but rose again, and 
signs of diaphragmatic pleurisy developed. 

{b) Boy ten years old, had been ill for two days with abdominal 
pain and vomiting following a blow on the abdomen and lower part of 
the chest. He was admitted to the hospital for acute traumatic peri- 
tonitis. Examination showed the abdomen distended, rigid, tender; 
the legs drawn up ; constipation ; a temperature of 99.5, soon rising 
to 103; the respiration 44 and the throat negative. On the next day 
undoubted signs of pleuro-pneumonia of the right base were found. 
Empyema developed later. 

Four other cases are reported ; one in a girl of seventeen and 
three in men, in which severe abdominal symptoms were produced 
by pneumonia or pleurisy. In the case of the girl the diagnosis of 
perforating gastric ulcer had been made, and operation was per- 
formed, but no signs of this condition were found. On the next 
day physical signs of pneumonia of the right base were found. In 
the case of one of the men operation was performed for supposed 
laceration of the spleen from trauma, the symptoms being due in 
reality to a traumatic pleurisy of the left side. The two other cases 
exhibited symptoms of peritonitis dependent on the presence of pyo- 
pneumothorax. 

Barnard refers to the fact that the older writers recognized the sim- 
ulation of abdominal disease by pneumonia or pleurisy. He speaks 
of cases reported by Andral and by Fagge. He says that the 
relaxation of the abdominal walls with each inspiration, the rapid 



PNEUMONIA AND PLEURISY. 54I 

respiration, the absence of weak or irregular pulse, the fact that the 
tenderness is superficial and disappears under firm pressure by the 
flat of the hand, and the sudden high elevation of temperature, speak 
against peritonitis and for pulmonary disease. 

IX. Comby and Zielinski {Arc^, de Med, des Enf, 1902, 741) 
report one case. Boy of eight years was attacked suddenly by vomit- 
ing, abdominal pain, constipation and fever. On the next day there 
was a temperature of 39.3 C, an anxious expression of face, pain and 
tenderness on the right side of the abdomen, no cough, and nothing 
abnormal in the lungs. On the fourth day vomitmg and distension of 
the abdomen developed. Appendicitis was thought of, but beginning 
physical signs of pneumonia of the right side were found. Crisis 
occurred on the seventh day. 

The writers caution against an early diagnosis based on what 
appear to be appendicular symptoms. There should be increased 
muscular resistance and deep induration present to justify the 
diagnosis of appendicitis. 

X. Cozzolino {Gas, degli Ospedali, 1903, XXIV, 45) reports one 
case. 

Girl of three years was suddenly attacked by high fever, severe 
abdominal pain, especially on the right side, vomiting and anorexia. 
Examination on this day showed the child lying on the right side with 
thighs strongly flexed, great abdominal pain and tenderness, tempera- 
ture of 39.7 C. pulse 150, rapid respiration, slight dyspnoea, dry cough 
and constipation. She vomited during the examination. Practically 
nothing abnormal was found in the lungs. After much persuasion 
palpation of the abdomen was permitted ; firm, steady pressure with 
the palm overcame the muscular contraction, and nothing abnormal 
was found at McBurney's point. On the next day the pain was 
slightly less ; the cough little worse, and vomiting had ceased, and in 
the evening characteristic signs of beginning pneumonia of the right 
base were discovered. Abdominal pain slowly diminished, and 
disappeared by the sixth day. • 

He believes that pressure with the fiat of the hand is a valuable aid 
in diagnosis, and dwells upon the caution to be exercised in basing 
an opinion on the ordinary train of symptoms of appendicitis. 

It is not necessary to review much further the individual cases or 
the general observations of the different writers as already quoted. 
There is evident a decided uniformity in most of the statements. 
They are in entire accord, too, with what the new cases I have 



34? MEDICAL SOCIETY OF NEW JERSEY. 

reported show. There is. namely, especially in early life, a well- 
recognized, long-known, but frequently forgotten, tendency for 
patients with pneumonia or pleurisy to refer to the abdomen the pain 
really produced in the chest. This is more liable to happen when the 
disease is situated in the lower part of the thorax, but there is reason 
to believe that it may occur also when it has attacked the upper por- 
tion. It is also more deceptive when the right side of the thorax is 
affected, since the right side of the abdomen is more liable to exhibit 
pain, and the presence of appendicitis is suggested. Combined with 
the abdominal pain in these cases there is also constipation and 
abdominal tenderness and distension. These symptoms, together 
with the vomiting which quite commonly ushers in an attack of 
pneumonia in childhood, easily produce a clinical picture very closely 
simulating that of appendicitis. 

The distinction is to be made by giving due consideration to (i) the 
sudden rise of temperature to 103 or thereabouts and the tendency to 
maintain this degree ; (2) the acceleration of respiration, which is out 
of proportion to the pulse rate or the pyrexia ; (3) the relaxation of 
the abdominal walls between the respirations ; (4) the diminution or 
disappearance of tenderness on deep pressure with the flat of the 
hand ; (5) the possible presence of cough. Finally, no operation for 
appendicitis should ever be performed until after a careful or perhaps 
repeated examination of the lungs has been made. All these points 
will, however, frequently fail to make the diagnosis certain, as the 
experience of some of the able observers quoted has shown. 

DISCUSSION. 

Dr. E. W. Hedges, of Piainiield. -When we remember that the 
six lower intercostal nerves are so distributed that some of the 
fibres run to the pleura and some to the abdominal muscles, I think 
it very easy to understand how irritation in the chest, involving 
perhaps the pleura, may be referred to the abdominal wall. There 
are some symptoms in common ~ the initial vomiting, the abdominal 
rigidity and the tenderness on pressure — but I think if the symptoms 
are welhconsidered, one should seldom make a mistake. The in- 
creased respiratory frequency in pneumonia, as compared with 
appendicitis; the dilation of the alae of the nose and the high 
temperature, are important diagnostic points^ If we made it a rule 
to examine the chest as a routine measure, I think we would seldom 
make this mistake, even in the first day of a pneumonia. 



some common deformities. 343 

Some Common Deformities and Their Prevention. 

BY D. T. BOWDEN, M. D., PATERSON, N. J. 

The question asked me by a physician a few days ago : "What has 
an orthopxdie surgeon to do with a case of poliomyelitis ?" suggested 
the title of this paper. 

How often, indeed, too often, have cases appeared in my private 
and dispensary practice with severe deformity of various types 
necessitating the use of the knife and much plastic work on 
bone, tendon and muscle, which, had they not been neglected, 
would never have reached such a degree of severity as to maim and 
cripple the person for life. In viewing my private records and those 
of the New York Orthopadie Hospital. I found so many cases of 
this kind, that this subject appeared to me to be of great importance. 

Contractures following poliomeyelitis, cerebral or spastic paralysis, 
pseudo-hypertrophic paralysis, obstetrical paralysis, encephalitis, 
chronic meningitis, hydrocephalus, meningeal hemorrhage and embo- 
lism, multiple neuritis, lead poisoning, etc., may reach the stage of 
confining the patient to a life in a wheel chair and make him a 
dependent upon the charity of a community. 

In septic conditions, at or near a joint, synovitis, tuberculous 
arthritis and burns, cicatricial contraction following which very 
often produces such extreme limitation of motion and deformity as 
to render the limb completely useless. 

In operations upon the bones and joints, the general surgeon 
seems to completely lose sight of the possibility of deformity follow- 
ing, seeming to only have in mind the curing of the affliction as it 
appears then. Though an osteotomy for bow-legs or knock-knee, 
an excision for tuberculous arthritis may have been skillfully per- 
formed, many times it accomplishes nothing, or even does harm, 
through the failure to furnish proper mechanical protection after. 
In the experience of the writer, cases have reported at the clinic, 
where osteotomy for bow-legs had been performed, with a return 
of the deformity in an exaggerated form ; or where a knock-knee 
has followed operation for the correction of bow-legs or vice versa. 

Such deformities as lateral and an tero- posterior curvature of the 
spine, rachitis, traumatic and acquired flat-foot, bow-legs and knock- 
knees, flexion deformities following tuberculous joint lesions, and 



344 MEDICAL SOCIETY OF NEW JERSEY. 

those following fractures and sprains, rheumatism and faulty positions 
in occupations, sitting or standing, faulty decubitus during long 
illness, all preventable, is a serious reflection upon the medical attend- 
ant, and should be, in the present light of our knowledge, almost 
unknown. 

Congenital deformities, as dislocation of the hip or shoulder, club> 
foot and hand are equally amenable to treatment and cure in the 
early stage. 

Time will not permit a detailed description of the proper line of 
treatment in each of these conditions, so I shall, with your kind per- 
mission, describe the common methods used in the most frequent 
diseases that lead to deformity. 

1st, — Infantile Paralysis. — The deformities following a neglected 
case of poliomyelitis are often painful to look upon, and are due to 
over-action of non-paralyzed muscles, gravity and weight of the 
body, the affected muscles failing to support the limb in normal line. 

Given a case of paralysis of anterior group of muscles, the dorsal 
flexors of the foot, and if neglected, we have a gradual retraction 
of the calf muscles with equinus deformity as the result, and to 
correct which, it becomes necessary to do a tenotomy, or what is 
still better, that operation known as ** tendon lengthening," to allow 
the heel to be brought down. At times, as a result of this deformity 
and the patient's effort to walk with the foot flat on the ground, we 
have a severe stretching of the ham-string tendons and hyper-exten- 
tion of the knee, occurring secondarily. The early application of a 
simple ankle support with an ordinary catch to limit extension or 
plantar flexion of the foot at 90^, thus preventing toe drop, would 
have rendered such an operation unnecessary and given a much better 
result. 

Following paralysis of the gastrocnenuius and soleus, we have 
calcaneus deformity with shortening of the plantar fascia, applica- 
tion of a brace with a reverse catch, so as to prevent dorsal flexion 
above 90** would have proven efficient. 

The anterior and posterior tibial muscles are alone the seat of 
permanent loss of power in many cases, and owing to an over-acting 
calf and perinei, we have the well-known paralytic valgus or flat-foot 
deformity, to prevent which, the early application of a brace with 
short inside bar and pad opposite the astragolus to prevent its dis- 
placement, would be the proper modus operandi. Paralysis of 



SOME COMMON DEFORMITIES. 345 

perineals causes the opposite deformity, talipes equino varus paralytica, 
in which condition the outside bar should be shortest and pad placed 
on outside. 

In paralysis of the quadriceps, the bars should be extended to the 
thighs ^with bands above and below the knee. Loss of ham-string 
power ; the same brace is indicated. 

Flexion of thigh on trunk is to be prevented in weakened extensor 
muscles or other causes, by extending the bars up higher and 
attaching to a band around the pelvis. 

So I might go on enumerating the deformities of other groups or 
combinations, but the principles already given will. I am certain, 
prove efficient, if combined to meet the demands of each individual 
case. 

Perhaps it would be well to explain that I use the word brace, 
meaning that any kind of a device, be it of gypsum, felt, aluminum, 
or steel, that will hold the extremity in proper relation to the body, 
will answer, but a properly fitted walking apparatus is to be preferred. 

In wrist-drop, severe stretching of the weakened extension tendons 
should be prevented by the use of the auterior hand splint, or any 
appliance that will hold the hand and forearm in an extended 
position. 

In the other forms of paralysis, before mentioned, it is generally 
the flexor and adductor muscles that are active in producing the 
malposition. Daily stretching, massage and exercise will in most 
cases suffice, and in all cases, if begun early and before pronounced 
deformity appears, together with a proper retentive apparatus. It 
has been the writer's good fortune to see several cases of spastic 
paralysis yield to stretching and manipulation with almost complete 
disappearance of spastic gait and deformity, but it requires patience, 
perseverence and a great deal of hard work. 

In chronic rheumatoid arthritis, faulty decubitus and malpositions, 
institute that method of reform that will bring about the desired 
change, and consists in preventing habitual and predisposing positions 
that lead to deformity. Insist that the patient keeps the limbs ex- 
tended and if contracture threatens, daily stretching, massage, and. 
if necessary, the application of splints will retain the extremities 
in their normal relations to the body. 

To genu varus and valgus, I will devote few words, as all know 
how amenable to treatment these are, if braces are applied before 



346 MEDICAL SOCIETY OF NEW JERSEY. 

the end of the third year of age, and some, as late as the fourth year. 

Before attempting to treat scoliosis, the causes should be carefully 
inquired into, and if due to a shortened limb, or a tilted pelvis, a high 
shoe should be worn. If to faulty position at school, advise a reverse 
of position in writing, or the erect posture. If rachitic, proper medi- 
cation and special exercise, together with application of either a 
Shaffer brace, a Knight, an aluminum or a plaster of paris corset. 
Most disfiguring and painful deformities follow neglect of these 
niethods. whereas, if carefully attended to in its incipiency, a perfect 
cure can be brought about. 

Flat-foot from any cause should be treated seriously, less it cause 
untold suffering and inconvenience. The application of a steel insole, 
of which the writer has found no better model than that devised by 
Dr. Royal Whitman, will often cause a disappearance of pain and 
disability that is almost magical. Cases of the most painful and 
deforming flat-foot with marked displacement of the astragalus and 
scaphoid bones following sprains have been referred to the writer and 
have required months of treatment to correct, which had the parts been 
put at rest and the foot retained in a position of varus would have 
been entirely prevented. I feel I cannot impress this point too forci- 
bly, as I know there is too great a tendency on the part of medical 
men to deal lightly with this form of injury. 

Congenital dislocation of the hip, easily amenable if treated in time,, 
becomes hopeless if neglected, and while not a severe deformity, it 
renders the one so afflicted less able to earn a livelihood at a standi 
ing occupation than her more fortunate sister. It has been the 
writer's good fortune to have successfully performed the " Lorenz " 
operation for the relief of this deformity on five cases, and hope at the 
next- meeting to report these cases, with photographs and X ray 
pictures. 

I know of no deformity more susceptible of cure than congenita) 
club-foot when seen early. Repeated stretching of the contracted 
muscles and the application of the proper retentive apparatus will 
bring about a perfect result and prevent humiliation and such spleenish 
utterance as has been attributed to the well-known poet, Lord Byron. 
Daily stretching until the feet can be put into a Valgus position, then 
they should be over corrected, put up in plaster of Paris, and so retained 
until child is able to walk, when a varus ankle brace should be 
applied. 



SOME COMMON DEFORMITIES. 347 

Deformities following tuberculous arthritis : 

The severe flexions following this disease should in every case be 
prevented by an early diagnosis and the application of an extension 
and stilting apparatus. 

It is unfortunate and much to be regretted that many cases do not 
reach the hands of the orthopedic surgeon until so much change has 
taken place through the destruction of bone and soft parts, so much 
alteration in the normal relation, that permanent disability must 
remain, and, though much can be done in extreme cases to improve 
the condition, yet complete obliteration of the marks of neglect is not 
accomplished, and the patient is consigned to a life of moral as well 
as physical suffering. 

The responsibility for this state of affairs rests mainly upon the 
shoulders of the family physician, for it is to him the mother first takes 
her child, and it is to him that this paper is chiefly directed. 

You who are called, at more or less frequent intervals, into the 
family fold, should be in a position to detect these abnormalities in 
their inctpiency, and to impress upon the mind of the parent the sad 
afflictions, the inconvenience and mental sufiFering that may follow 

neglect in applying the proper preventive treatment before pro- | 

nounced deformity appears. { 



CONSTITUTION. 349 

INTRODUCTORY NOTE. 



It will be remembered that all members of the society were invited 
to meet on the evening before the opening of the last annual session 
to consider the proposed new constitution and by-laws. At that 
meeting many changes were suggested. The committee on revision 
endeavored to make these changes, but owing to the limited time (a 
few hours only before presentation to the Society) it failed to entirely 
and properly incorporate them, and as a consequence the instrument 
as adopted was afterwards found to be very imperfect from omissions, 
repetitions and inaccuracies of expression. 

The committee on publication, after consultation with the former 
committee on revision, has corrected these very apparent errors with- 
out making any essential changes in the main features or requirements 
of the constitution and by-laws as adopted. This action has been 
approved by the Board of Trustees, and by their order these instru- 
ments as corrected are printed below. The action of the Commitee 
will also be presented to the Society for its approval at the next annual 

meeting. 

Publication Committee. 



CONSTITUTION. 



ARTICLE I. 
CONSTITUTION, 

Name. — The name and title of this organization shall be " The 
Medical Society of New Jersey." 

ARTICLE II. 

PURPOSE OF THE SOCIETY. 

Object. — The purpose of this society shall be : First — To federate 
and organize the medical profession of the State of New Jersey. 
Second — To unite with similar organizations of other States, to 
compose the American Medical Association. Third — To advance 
medical science and elevate professional character. To safeguard the 
material interests of the profession and promote friendly relations 
among its members. To educate the public in preventive medicine 
and hygiene ; and in all to render the medical profession most 
capable in its service to humanity. 



350 MEDICAL SOCIETY OF NEW JERSEY. 

ARTICLE in. 
COMPONENT SOCIETIES. 

The Component Societies shall consist of County Medical Societies 
which hold charters from the Medical Society of New Jersey. 

ARTICLE IV. 

COMPOSITION OF THE SOCIETY. 

Section i. — The Medical Society of New Jersey shall be com- 
posed of members in good standing of the component Societies, and 
shall be designated as fellows, officers and delegates. 

Sec. 2.— (a) Fellows of the Medical Society of New Jersey shall 
consist of the ex-presidents. 

(b) Officers, — The officers of the Medical Society of New Jersey 
shall be a president, three vice-presidents, a corresponding secretary, 
a recording secretary, a treasurer and a board of trustees. 

(c) Delegates. — Delegates shall be permanent, annual and 
associate. 

permanent delegates. 

Sec. 3. — At the annual meeting of each component society in 1906, 
and at every third annual meeting thereafter, and at no other time, 
except in cases where vacancies occur as specified in the last para- 
graph of this section, each component society may, by individual 
ballot, by a three-fourths vole of the members present, select one 
nominee for permanent delegate to the Medical Society of New 
Jersey, and component societies having thirty or more members may 
also, every third year, select in the same manner, one additional 
nominee for every thirty members or major fraction thereof, provided, 
that every such nominee shall have been a member in good standing 
of a component society for five years ; and provided that no compon- 
ent society shall be entitled to more permanent delegates than one- 
tenth of its regularly certified membership ; and when, from any 
cause, this number is exceeded, the component society having such 
excess shall not be privileged to select nominees for permanent 
delegates until this disproportionate representation shall have ceased 
to exist ; provided, further, that each nominee shall present a certi- 
ficate signed by the president and secretary of his component society 
in the following form : 



CONSTITUTION. 35 1 

N.J 190.. 

This is to certify that M. D., was nomi- 
nated for permanent delegate to the Medical Society of New Jersey, 

on the day of 190... by the component 

society of the County of according to the re- 
quirements of the constitution and by-laws of the Medical Society of 
New Jersey. 

The house of delegates shall have the power to elect or reject any 
nominee for permanent delegate and a three-fourths vote by ballot 
of all members present shall be necessary to the election of a per- 
manent delegate to the Medical Society of New Jersey. 

The following classes of permanent delegates shall be deprived of 
their privileges as permanent delegates, and their names, after having 
been announced to the Society by the secretary, and without any 
accompanying defense or satisfactory excuse, shall be stricken from 
the roll : 

1st. Those who lose their membership in their respective com- 
ponent societies. 

2d. Those who have failed to attend two consecutive annual 
meetings of the Medical Society of New Jersey. All excuses for 
absence shall be made in writing to the judicial council, and its 
decision shall be final. 

All permanent delegates whose component societies are in arrears 
for dues to the Medical Society of New Jersey shall be suspended 
from all the privileges of this society until such arrears are paid. 

After the death of a permanent delegate or a nominee for permanent 
delegate, the secretary of the component society of which said delegate 
or nominee was a member shall send formal notice of such death to 
the recording secretary of the Medical Society of New Jersey, and 
said recording secretary shall thereupon notify said component society, 
through its secretary, that it may select at its next annual meeting (or 
at a meeting specially called for this purpose) a nominee to fill the 
vacancy. The names of all permanent delegates stricken from the 
roll shall be reported by the recording secretary of the Medical Society 
of New Jersey to the secretaries of the component societies which 
they respectively represented, and said component societies may select 
at their next annual meeting nominees to fill these vacancies. 
ANNUAL DELEGATES. 

Sec. 4.— (tf) The annual delegates to the Medical Society of 



352 MEDICAL SOCIETY OF NEW JERSEY. 

New Jersey shall be elected at the annual meeting of the component 
societies in accordance with requirements of the constitution of this 
society, and shall with the permanent delegates and reporters, repre- 
sent their respective component societies in the house of delegates. 

ip) Each component society shall send each year to the house of 
delegates of the Medical Society of New Jersey one annual delegate for 
every twenty-five members (or major fraction thereof) reported to the 
recording secretary ; provided the said component society shall have 
made its annual report and have paid its annual assessment as pro- 
vided in this constitution and by-laws. Nothing, however in this 
section shall debar any component society from having at least one 
annual delegate. 

{c) In the absence of an annual delegate of a component society 
in good standing, the presiding officer of the Medical Society of New 
Jersey may, on the recommendation of the members present from the 
said component society, publicly fill the vacancy from among the 
associate delegates of said society, and such alternate shall have all 
the rights of an annual delegate. 

ASSOCIATE DELEGATES. 

Sec. 5. — All members of component societies in good standing, not 
otherwise included in the membership of the Medical Society of New 
Jersey, are hereby constituted associate delegates, and may participate 
in all the privileges of the general sessions. 

PRIVILEGED MEMBERS. 

HONORARY MEMBERS. 

Sec. 6.— Honorary members shall be physicians and surgeons who 
have attained distinction in the profession, and may be elected by a 
two-thirds vote of the house of delegates ; provided, they shall have 
been recommended for election by the committee on honorary mem- 
bership; and provided further, that the number of living honorary 
members shall not exceed fifteen. They shall have the privilege of 
discussing all scientific questions presented at the sessions of the 
society. 

GUESTS. 

Sec. 7. — Any physician, resident or non-resident of this State, may 
upon invitation of the society or of the house of delegates, become a 
guest during the annual meeting, and shall be accorded the privilege 
of participating in the scientific work of the society. 



CONSTITUTION. 353 

ARTICLE V. 
HOUSE OF DELEGATES. 

Section i. — The house of delegates shall be the legislative body 
of the Medical Society of New Jersey. 

Sec. 2.— Members of the house of delegates shall consist of the 
fellows, officers of the society, permanent and annual delegates, 
reporters* councillors and chairmen of the standing committees. 

ARTICLE VI. 

board of TRUSTEES. 

Section i. — The board of trustees shall be the executive body of 
the society and shall be composed of the fellows, the president, the 
first vice-president and the recording secretary. 

ARTICLE VII. 
SECTIONS. 

Section i. — The house of delegates may provide for the division 
of the scientific work of the Medical Society of New Jersey into 
appropriate sections, when the necessity for such division arises, sub- 
ject to the approval of the board of trustees. 

Sec. 2. — The house of delegates shall organize councillor districts 

within the State. Said districts shall be composed of three or more 

component societies. The house of delegates shall elect a councillor 

from each district, which councillors collectively shall constitute the 

judicial council. 

ARTICLE VIIL 

meetings. 

Section i. — The Medical Society of New Jersey shall hold an 
annual meeting, during which there shMl be held daily not less than 
one general session, which shall be open to all registered members. 

Sec. 2. — The time and place for holdmg the annual meeting shall 

be fixed by the house of delegates for each succeeding year. The 

board of trustees may change the time and place of meeting when 

deemed necessary. 

ARTICLE IX. 

OFFICERS. 

Section i. — All ofncers except the secretaries, treasurer and mem- 
bers of the board of trustees, shall hold office for one year only, or 
until their successors are elected. Members of the board of trustees,, 
except the first vice-president and recording secretary, may hold office 
so long as they are members in good standing in this society. 

2S 



354 MEDICAL SOCIETY OF NEW JERSEY. 

Sec. 2. — The officers of the Medical Society of New Jersey, except 
the board of trustees, shall be elected by the house of delegates in 
the afternoon of the second day of the annual meeting, by ballot (a 
majority of the votes cast being necessary to an election), it being 
hereby provided that no member shall be eligible to more than one 
office at the same time except the president, the first vice-president 
and recording secretary, who, by virtue of their office, are members of 
the board of trustees. And it is further provided that all nominations 
to fill vacant offices occurring during the interim between the annual 
meetings by reason of death, resignation, misconduct, removal from 
the state or otherwise, shall be made by the board of trustees at the 
opening of the first session, and the election of said . officers shall 
immediately follow. 

ARTICLE X. 

FUNDS AND EXPENSES. 

Section i.— Funds for meeting the current expenses of the Medical 
Society of New Jersey shall be provided for by an equal per capita 
assessment upon each component society, by donations, by sales of its 
publications, and from miscellaneous revenue. During the annual 
meeting funds may be appropriated by the house of delegates subject 
to the approval of the board of trustees for the expenses of the annual, 
meeting, for publications, for expenses of officers and committees, but 
for no other purposes, unless authorized by a two-thirds vote of the 
house of delegates and approved by the board of trustees. 

Sec. 2. — The board of trustees may incur any necessary expense 
ad interim, 

ARTICLE XL 
SEAL. 

The seal of the Medical Society of New Jersey heretofore adopted 
shall continue, until otherwise ordered, to be the seal of this society. 

ARTICLE XII. 

AMENDMENTS. 

The house of delegates may amend any article of this constitution 
by a two-thirds vote of the members present (not less than fifty) at 
any annual meeting, provided, that such amendment shall have been 
submitted in writing at a previous annual meeting, and that it shall 
have been officially sent to each component society at least one month 
before the annual meeting at which final action is to be taken. 



BY-LAWS. 355 

BY-LAWS. 



CHAPTER L 

MEMBERSHIP. 

Section i. — The fellows and officers of, the delegates (permanent 
and annual) to. the Medical Society of New Jersey, are members, 
by act of incorporation ; associate delegates, honorary members and 
guests by privilege of the constitution. 

Sec. 2. — The secretary of each component society shall furnish to the 
recording secretary of the Medical Society of New Jersey, at least one 
month before the annual meeting, a certified roster of its total enrolled 
membership ; a list, as complete as possible, of all non-affiliating 
physicians in the county ; a list of its officers, annual delegates and 
reporter ; also a list of the members who have paid their assessments 
and are otherwise in good standing, which latter list shall be prima 
facie evidence of their right to register at the annual meeting, and 
shall form the basis of representation for the component society. 

Sec. 3. — No person who is under sentence of suspension or expul- 
sion from any component society of the Medical Society of New 
Jersey, or whose name has been dropped from its roll of members, 
shall be entitled to any of the rights or privileges of this society, nor 
shall the said member be permitted to take part in any of its proceed- 
ings, until such time as said member shall have been relieved of such 
disability. 

Sec. 4. — All members and delegates in attendance at the annual 
meeting of this society shall write their names and addresses in the 
registration book, and failing so to do shall be considered as absent. 

Sec. 5. — All annual delegates of the Medical Society of New Jersey 
shall produce a certificate of election at each annual meeting, signed 
by the president and secretary of the component society which they 
respectively represent ; and no annual delegate will be permitted to 
sit as a member of the house of delegates without said certificate, 
nor unless the component society from which he is a delegate shall 
have paid its annual assessment. 

Sec. 6. — When a member's right to membership has been verified 
by the committee on credentials, the said member shall receive a cer- 
tificate, which certificate shall be evidence of his right to the privi- 



356 MEDICAL SOCIETY OF NEW JERSEY. 

leges of membership. No member or delegate shall be permitted to 
take any part in the proceedings of this society until the provisions 
of this chapter have been complied with. 

CHAPTER II. 

ANNUAL AND SPECIAL MEETINGS. 

Section i.— The Medical Society of New Jersey shall hold an 
annual meeting at such time and place as may be fixed by the house 
of delegates or by the board of trustees. 

Sec. 2. — Special meetings of the Medical Society of New Jersey or 
of the house of delegates shall be called by the president upon the 
petition of twenty or more members representing four or more com- 
ponent societies, or upon the request of the board of trustees. 

CHAPTER IIL 
general meeting. 

Section i. — A general meeting shall include all registered mem- 
bers, honorary members and guests, all of whom shall have equal 
rights to participate in the proceedings. The president shall preside 
over all meeetings, or. in his absence, or disability, or by request, the 
vice-president in the order of seniority shall preside. The president's 
and third vice-president's annual addresses shall be delivered before 
the general meeting as shall be arranged for in the official programme. 

Sec. 2.— The general meeting may create committees for scientific 

investigations of special interest or importance to the profession or 

public, and may receive and dispose of reports of the same, but no 

- expense shall be incurred in connection therewith until recommended 

by the house of delegates and approved by the board of trustees. 

Sec. 3. — The order of exercises, papers and discussions as set forth 
in the official programme shall be followed from day to day until 
completed, unless otherwise ordered by the society. 

Sec. 4.— No address delivered or paper read before the Medical 
Society of New Jersey, with the exception of those delivered by the 
president, the third vice-president and invited orators, shall occupy 
more than twenty minutes in its delivery or reading, and no member 
shall speak longer than five minutes, nor more than once, on any 
subject unless by permission of the society. 

Sec. 5. — All papers and reports presented to the society shall be 
its property, and any author failing to deposit the same with his name 



BY-LAWS. 357 

with the recording secretary when read may be debarred fron) having 
his paper published in the Transactions. Permission to publish the 
same in medical journals may be granted by the committee on publi- 
cation. 

CHAPTER IV. 

HOUSE OF DELEGATES. 

Section i. — Tfte house of delegates shall meet annually at the 
time and place of the annual meeting of the Medical Society of New 
Jersey, and shall arrange its sessions so as not to conflict with the 
general meetings of the society, nor with the sessions held for the 
president's and third vice-president's addresses and for the annual 
orations. The house of delegates may meet in advance of, with, or 
remain in session after the final adjournment of the annual meeting. 

Sec. 2. — Twenty annual delegates, representing at least four com- 
ponent societies in good standing, shall constitute a quorum, and all 
of the meetings of the house of delegates shall be opened to the 
members of the Medical Society of New Jersey, but only members of 
the house of delegates shall have a right to vote. 

Sec. 3. — The house of delegates shall consider the reports of all 
component societies, and shall have authority to make such recom- 
mendations and adopt such measures as they may deem most efficient 
for building up and increasing the interest in societies already 
existing; to organize the profession in counties where afiiliated 
societies do not exist, and to issue charters as hereinafter provided. 

Sec. 4. — The house of delegates shall have authority to appoint 
committees for special purposes from among the members of the 
Medical Society of New Jersey, and such committees may report to 
the '^house of delegates in person and participate in the debates 
thereon. 

Sec. 5. — The house of delegates or board of trustees shall approve 
all memorials and resolutions issued in the name of the Medical 
Society'ofJNew Jersey before the same shall become effective. 

CHAPTER V. 
election of officers. 
Section i. — AH elections shall be by ballot and a majority of the 
votes cast shall be necessary to elect. 

Sec. 2. — On the first day of the annual meeting the president shall 



358 MEDICAL SOCIETY OF NEW JERSEY. 

ask all delegates present from each component society to meet at the 
close of the first session to elect a member to the nominating com- 
mittee and to notify the recording secretary of the member so elected, 
and these members, together with the fellows, shall constitute the 
nominating committee. This committee shall report the result of its 
deliberations to the house of delegates in the form of a ticket con- 
taining the names of one or more members for each of the offices to 
be filled at that annual meeting, also nominees for standing committees, 
councillors for the different districts, delegates to the American 
Medical Association and to corresponding state medical organizations. 

Sec. 3. — The report of the nominating committee, and the election 
of officers, standing committees, councillors, delegates to the American 
Medical Association, and the corresponding state medical organiza- 
tions, for the ensuing year, shall be the first order of business of the 
house of delegates in the afternoon of the second day of the annual 
meeting. 

Sec. 4. — Nothing in this chapter shall be construed to prevent 
additional nominations being made by members of the house of dele- 
gates. 

CHAPTER VI. 

DUTIES OF OFFICERS. 

Section i. — The president shall preside at all meetings of the 
Medical Society of New Jersey and of the house of delegates, pre- 
serve order and decorum in debate, give a casting vote when neces- 
sary, appoint all committees not otherwise provided for. order report^, 
enforce the observance of the by-laws, and perform such other duties 
as custom and parliamentary usage may require. He shall also deliver 
an annual address at such time and place as may be arranged for by 
the programme committee ; shall fill all vacancies made in the offices 
except that of treasurer of the society during the interim by rea- 
son of death, resignation, or removal from the state, and all persons 
so appointed shall serve until the next annual meeting, when all 
vacancies so filled by ad interim appointments shall be regularly 
filled by the house of delegates as provided for in Article IX, Section 
2, of this constitution. 

Sec. 2. — The vice-presidents shall assist the president in the dis- 
charge of his duties, and in the absence or disability of the president 
the vice-president in order of seniority, shall preside at all meet- 



BV-LAWS. 359 

ings of the Medical Society of New Jersey and of the house of 
delegates, and perform all of the duties pertaining to the office. In case 
of vacancy in the office of the president during the interim by death, 
resignation, or removal, the vice-president in order of seniority shall 
perform all the duties pertaining to the office of president during the 
interim until the first succeeding annual meeting thereafter. 

Sec. 3.— The third vice-president shall prepare and read an essay 
upon some medical or allied subject at the first annual meeting sub- 
sequent to his election. 

Sec. 4.— The treasurer shall give bond for the trust reposed in him 
as required by the board of trustees. He shall demand, receive and 
preserve all funds due the Medical Society of New Jersey, together 
with bequests and donations ; keep a correct list of the same, together 
with the name of the respective donors. He shall not pay any moneys 
out of the treasury except by the written order of the president, 
approved by the board of trustees. His accounts shall be subject to 
an examination by an auditing committee appointed from the board 
of trustees at such times as they or the house of delegates may order, 
and he shall annually render a full statement of all the transactions of 
his office at the annual meeting of this society. He shall charge upon 
his books the assessment against each component society at the end 
of the fiscal year, collect and make proper credits for the same, and 
perform such other duties as may be assigned to him. 

Sec. 5. — It shall be the duty of the board of trustees to annually 
organize by electing a chairman and secretary ; to exercise a general 
supervision over the affairs of the society, with authority to recom- 
mend and to act for its betterment whenever opportunity offers ; to 
keep full minutes of all meetings ; to give to the house of delegates a 
summarized brief of its proceedings and recommendations, and to 
yearly publish in the Transactions a full report of the same; to require 
and hold the official bond of the treasurer for the faithful execution 
of his duties ; to annually audit and authenticate his accounts, and 
to include a statement of the same in the general report. The 
board of trustees shall have authority to advise in the deliberations 
of the several standing committees, and especially to supervise 
the duties and labors of the publication committee, and, when 
necessary, to appoint an editor and such other assistants as the 
demands of the society may require ; to refer and otherwise dis- 
pose of all business properly arranged for its disposition ; to lease 



360 MEDICAL SOCIETY OF NEW JERSEY. 

sell or otherwise convey or dispose of any or all property of the 
Medical Society of New Jersey, both 'personal and real, and execute 
therefor, good and sufficient lease, deed or other conveyance; 
to determine all salaries, to pass upon all recommendations, 
and order all necessary expenditures for the society. In the event of 
a vacancy in the office of treasurer by death, or otherwise, the board 
of trustees shall select one of its members to fill the vacancy. 

Sec. 6. — The recording secretary shall have custody of the consti- 
tution and by-laws, and of the records of this society and of the house 
of delegates ; shall attend the meetings, record the proceedings, and 
give notice of all the regular and special meetings of this society and of 
the house of delegates. He shall notify the chairman of each com- 
mittee of his election or appointment, with the names of his associates, 
together with the subject referred to the committee, furnish delegates 
to the American Medical Association and corresponding state medical 
organizations, with proper credentials, demand and receive from the 
component societies a copy of the proceedings of their first meeting, 
file the same among the archives of this society, and perform such 
other duties as may be assigned him by the house of delegates. He 
shall keep a record of the election of all permanent delegates, and 
report to the State society each year which component societies are 
entitled to additional permanent delegates, and the number, and shall 
also report the names of all such delegates as shall have forfeited 
their membership. He may employ assistance when authorized by 
the house of delegates or by the board of trustees. 

Sec. 7. — The corresponding secretary shall have charge of, and 
custody over, all letters and communications transmitted to this 
society, and shall keep a verbatim copy of all communications sent 
out in the name of the society. It shall be his duty, agreeable to the 
directions of the society, to write and answer letters, and to manage 
the general correspondence of the Medical Society of New Jersey and 
to report thereon to the society at its next annual meeting. He shall 
transmit to the secretaries of the several component societies infor- 
mation upon such subjects as have been acted upon in this society 
relative to their respective interests, and notify the honorary members 
of their election to this society ; transmit to them a copy of the con- 
stitution and by-laws ; provide for, and take temporary charge of, 
the registration of all members, delegates and guests at the annual 
meeting ; preserve all records until relieved of them by the society. 



BY-LAWS. 361 

and perform such other duties as may be required by his office or 
assigned to him by the society. 

CHAPTER VII. 

REPORTERS. 

Each component society shall elect one of its members a reporter, 
whose duty it will be to furnish to the committee on scientific work a 
brief and intelligent report of important transactions of his society, of 
special extracts from papers read, of interesting cases reported, and 
of the prevalence of contagious and other diseases in the county, of 
the removal of any member from the society by death or otherwise, 
and of the members elected during the year ; also general information 
of importance to this society. The reporter will forfeit his right to a 
seat in the house of delegates, and no credit will be given to him by the 
committee on scientific work, unless his report is received at least 
thirty days before the annual meeting of the Medical Society of New 
Jersey. 

CHAPTER VIII. 
COUNCILLORS. 

Section i. — The councillors shall be regularly nominated by the 
nominating committee and elected by the house of delegates. 

Sec. 2. — Collectively, the council shall be composed of the councillors 
of the Medical Society of New Jersey, and constitute a board of 
censors of this society known as the judicial council. The council 
shall consider all questions involving the rights of members, whether 
in relation to each other, to members of other societies, or to the 
members of this society. All questions of an ethical nature and 
excuses from permanent delegates shall be referred to this council 
without discussion. It shall hear and decide all questions of 
discipline affecting the conduct of members, and shall decide all 
appeals taken from the decision of an individual councillor. Its 
decision in all such cases shall be final. 

Sec. 3.— The judicial council of the Medical Society of New Jersey 
may hold daily sessions during the annual meeting of the society, and 
at such other times as necessity may require, subject to the call of the 
chairman, or upon the petition of three councillors. It shall meet on 
the last day of the annual meeting of the society for reorganization 
and for the outlining of the work for the ensuing year. At this meet- 



362 MEDICAL SOCIETY OF NEW JERSEY. 

ing it shall elect a chairman and secretary, and shall keep a permanent 
record of its proceedings, and through its chairman make an annual 
report to the house of delegates. 

Sec. 4. — Each councillor shall visit each component society in his 
district at least once a year, for the purpose of inquiring into the 
condition of the profession and for improving and increasing the zeal 
of the society in its scientific work. He shall make an annual report 
to the house of delegates of the condition of the profession in each 
component society in his district. The necessary travelling expenses 
incurred by said councillors in the line of the duties herein imposed 
may be allowed by the house of delegates upon the presentation of 
the proper itemized statement. 

CHAPTER IX. 

COMMITTEES. 

Section i.— The standing committees shall be as follows : 

{a) TO BE ELECTED. 
Arrangements. 



Committee on - 



Nominations. 

Programme. 

Scientific work. 

Public hygiene and legislation. 

Publication. 



{b) TO BE APPOINTED. 

C Credentials. 
Committee on < Business. 

( Honorary membership. 

COMMITTEE ON ARRANGEMENTS. 

Sec. 2. — The committee on arrangements shall consist of five mem- 
bers who shall be regularly nominated and elected, three of whom may 
be named from the component society of the county in which the next 
annual meeting is to be held. The president and recording secretary 
are ex-officio members of this committee. 

It shall be the duty of this committee to provide suitable accom- 
modations for the meeting places of the society, viz.: The general 
session, house of delegates, board of trustees, the various committees 
and exhibits. This committee shall have charge of all matters and 
details pertaining to the general arrangements, and shall have power 
to enlarge by creating sub-committees as necessity or urgency may 
require. 



BY-LAWS. 363 

The chairman shall report in writing an outline of the arrangements 
to the president for his approval, and subsequently to the chairman 
of the programme committee for publication, and shall make 
announcements during the sessions as occasion requires. 

PROGRAMME COMMITTEE. 

Sec. 3. — The programme committee shall consist of the recording 
secretary as chairman, and two additional members (one of whom 
after the first year shall be elected annually) for two years. It shall 
be the duty of this committee, after receiving the titles, together with 
brief abstracts of the papers to be read, with author's names attached' 
to prepare and issue a programme announcing the order in which the 
papers, discussions and all matters of business are to be presented, 
which order shall be followed as nearly as practicable. All papers 
must be announced to the chairman of the committee thirty or more 
days before the annual meeting. 

NOMINATING COMMITTEE. 

Sec. 4. — The nominating committee shall be selected on the first 
day of the annual meeting, as provided in Chapter V, Section 2, 
and shall perform the duties therein assigned, and such others as may 
be referred to it by the house of delegates. 

COMMITTEE ON SCIENTIFIC WORK. 

Sec. 5. — The committee on scientific work shall consist of three 
members, one of whom, after the first year, shall be annually elected 
for three years. 

This committee shall present at each annual session a summary 
report of the proceedings and recommendations of the respective 
component societies, together with the incidents and legal decisions of 
professional interest, and of special progress made. It shall arrange 
symposia upon subjects of its own selection ; invite special orators to 
read essays or deliver orations from time to time, and otherwise 
extend the interests and scientific work of the society as it may elect, 
and report to the programme committee at least thirty days before 
the annual meeting. 

COMMITTEE ON PUBLIC HYGIENE AND LEGISLATION. 

Sec. 6. — The committee on public hygiene and legislation shall be 
composed of six members. After the first year, two members shall be 
elected annually to serve for three years. It shall be the duty of this 
committee to look after all matters, hygienic and legislative, which shall 



364 MEDICAL SOCIETY OF NEW JERSEY. 

be referred to it by the house of delegates, and to annually hold at 
least one meeting, at which each component society may make known 
its recommendations through its reporter; and a summary of the 
same shall be formulated and presented to the house of delegates. 
The president and recording secretary shall be ex-officio members of 
this committee. 

COMMITTEE ON PUBLICATION. 

Sec. 7.-^The committee on publication shall consist of the record- 
ing secretary, as chairman, and two other members, who shall be 
elected annually. All reports, papers and discussions may be referred 
to this committee for publication, but the committee shall have 
authority to curtail such documents or to print abstracts thereof, and 
may return to the author any paper deemed by them unsuitable for 
publication in the Transactions, with reasons for non-publication. 
The committee shall have authority to publish and distribute the 
annual Transactions. 

CHAPTER X, 
Committees to be Appointed, 
committee on credentials. 
Section i. — The committee on credentials shall consist of three 
members, viz.: corresponding secretary, treasurer, and one member 
to be appointed by the president. It shall be the duty of this com- 
mittee to examine all credentials and certificates presented by mem- 
bers and delegates, and when found in accordance with the require- 
ments of Article IV., Sections i to 7, and Chapter I., Sections 2 to 6, 
inclusive, of the. constitution and by-laws of this society, to issue to 
each, individually, a certificate or badge which, when regularly pre- 
sented, shall be evidence of their right to membership. This com- 
mittee shall keep a record of all issues, together with the names and 
addresses of the delegates and members, and compare the same with 
the roster from the respective component societies. 

THE BUSINESS COMMITTEE. 
Sec. 2. — The business committee shall be composed of five mem- 
bers of the house of delegates, appointed by the president. Any 
questions or business before the society or the house of delegates for 
consideration may be referred to the business committee for subse- 
quent report or recommendation. 



BY-LAWS. 365 

COMMITTEE ON HONORARY MEMBERSHIP. 

Sec. 3.— The honorary membership committee shall be composed 
of three fellows appointed annually by the president, whose duty it 
shall be to inquire into the standing and qualifications of all nominees 
for honorary membership in this society, and report the same with 
their recommendations to the house of delegates at the next annual 
meeting of the society. 

CHAPTER XI. 

Section i. — Any oSicer of this society, for sufficient reason, may 
resign his office, or he may be removed therefrom by order of the 
house of delegates when guilty of neglect of duty, improper conduct, 
or upon violation of the constitution and by-laws. In either or all 
cases, the society shall fill the vacancy so made as provided for in 
Article IX. of the constitution. Chapter V. and Chapter VI., Section 
I, of the by-laws. 

CHAPTER XII. 

ASSESSMENTS AND EXPENDITURES. 

Section i. — An assessment of two dollars per capita on the mem- 
bership of the component societies is hereby made the annual dues of 
this society. Thirty days before the annual meeting of the Medical 
Society of New Jersey, the treasurer of each component society shall 
forward to the treasurer of this society the amount of its assessment 
with a list of the members who have paid their assessments and are 
otherwise in good standing. 

Sec. 2. — Any component society which fails to pay its assessments 
or to make the reports as required in this constitution and by-laws 
shall be held as suspended, and none of its members or delegates 
shall be permitted to participate in any of the business or proceedings 
of the society (unless the disability be removed by the house of dele- 
gates) until all requirements have been satisfied. 

Sec. 3. — All motions or resolutions appropriating money not 
hereinbefore provided for shall specify a definite amount, or so much 
thereof as may be necessary for the purposes indicated, and must be 
recommended by the house of delegates and approved by the board 
of trustees. 



366 MEDICAL SOCIETY OF NEW JERSEY. 

CHAPTER XIII. 
RULES OF CONDUCT. 
The " principles of medical ethics " adopted by the American 
Medical Association shall govern the conduct of the members of this 
society in their relations to each other and to the public. 

CHAPTER XIV. 

RULES OF ORDER. 

The deliberations of the Medical Society of New Jersey shall be 
governed by parliamentary usage as contained in Roberts' •* Rules of 
Order," unless otherwise determined by a two-thirds vote of its 
respective bodies. 

CHAPTER XV. 

COMPONENT SOCIETIES. 

Section i. — All county medical societies of the state of New Jer- 
sey which shall adopt the principles of organization in accord with 
this constitution and by-laws, may, upon application to the house of 
delegates, receive a charter from and thereby become a component 
society in affiliation with the Medical Society of New Jersey. 

Sec. 2. — Charters shall be issued only upon the order of the house 
of delegates after approval by the board of trustees, and shall be 
signed under seal by the president and recording secretary of this 
society. Upon the recommendation of the house of delegates, the 
board of trustees may revoke the charter of any component society 
whose actions are in conflict with the letter or spirit of this constitution 
and by-laws. 

Sec. 3. — There can be but one component medical society chartered 
in any county in this state. 

Sec. 4. — Each component society shall judge of the qualifications 
of its own members, but as such societies are the only portals to the 
Medical Society of New Jersey, and also to the American Medical 
Association, every reputable and legally registered physician who is 
practicing, or who will agree to practice non-sectarian medicine, shall 
be eligible to membership in a component society when regularly 
qualified. 

Sec. 5. — Any physician who may feel agrieved by the action of the 
component society of his county in refusing him membership, or in 
suspending or expelling him, shall have the right to appeal through 
his district councillor to the board of councillors. 



BY-LAWS. 367 

Sec. 6. — When hearing appeals, a councillor or the judicial council 
may admit written or oral evidence, but in all cases efforts at concilia- 
tion should precede such hearings. 

Sec. 7. — When a member in good standing in a component society 
moves to another county of this state, his name, upon request, may be 
transferred to the roster of the component society in whose juris- 
diction he moves. 

Sec. 8. — Any physician living in or near a county line may hold his 
membership in the component society most convenient for him to . 
attend, on permission from the component society in whose jurisdiction 
he resides. 

Sec. 9. — The secretary of each component society, in addition to 
that of its own members, is recommended also to keep a list of non- 
affiliating, registered physicians of the county, with full name, address, 
college and date of graduation and date of license to practice in this 
state, together with such other information as may be deemed 
important to the society. He shall furnish an official report containing 
such information upon blanks supplied him for the purpose, by the 
secretary of this society, when requested to do so. The roster kept 
should indicate any changes in the personnel of the profession by 
death, removal to, or from the county, or by withdrawal from the 
society, and in making such a report he should endeavor to include 
an account of every physician who has lived, or is now living, in the 
county during the year. 

CHAPTER XVI. 

REGULATIONS CONCERNING THE DEGREE OF 
DOCTOR OF MEDICINE. 

Section i.— Candidates for the degree of Medicina Doctor, may 
apply to any district society of this state, and shall be admitted to 
examination under the following rules and regulations : 

i«t.— Each district society shall appoint annually, or pro re nata, 
a committee of not less than five members, who shall conduct the 
examinations. 

2d.— All examinations shall be in the presence of the society at a 
regular meeting; and no candidate shall be examined until he has 
given satisfactory evidence of having reached the age of twenty-one 
years, is of good moral character, that his preliminary education has 



368 MEDICAL SOCIETY OF NEW JERSEY. 

been such as to qualify him for the study and practice of medicine, 
and has pursued his medical studies in some medical college whose 
requirements do not fall below the minimum standard of the 
Association of American Medical Colleges. 

3d. — The examination shall extend to all of the branches taught in 
the medical schools, recognized as aforesaid, and the candidate shall 
then be balloted for by the society. If he shall receive the approving 
votes of two-thirds of all the members present, the presiding officer 
shall give a certificate to that effect to the candidate. 

4th. — The certificate may be presented at the next or any subsequent 
regular meeting of this society, not extending beyond the period of 
three years, with a written thesis upon some medical subject ; and if, 
upon a ballot, they shall be approved by a majority of the members 
present, the candidate, upon the payment of fifteen dollars, shall be 
entitled fo receive a diploma in the following form : 



Form of Diploma for the degree of Doctor of Medicine, 

SOCIETAS MEDICA REIPUBLICiE NEO-CiESARIENSIS. 

Legibus constituta^ omnibus has Literas lecturis, 

SALUTEM : 

Quoniam A, B. vir ornatus ei moribus inculpatus, qui omnibus 
studiis ad Medicines et Chirurgice usum scientiamque spectanibus 
animum fidelitur intendit, et opinionibus hominum faventibus, nobis 
commendatus est ut ad gradum Doc tor is Medicines Chirurgietque 
proveheretur, 

Notum sit quod placet nobis, auctoritate hacce societate, collata 
inquisitione ejus peritice diUigentis sima coram viris selectis et 
eruditis, secundum leges hujusce societatis, imprimis habita, supra- 
dictum A, B, titulo, graduque Medicines et Chirurgce Doctor is 
adornare, eique omnia jura, privilegia et honor es ad istum gradum 
pertinent ia, dedere et concedere, 

Reipublica Neo-Ccesariensis ilium ad gradum honorarium Medi- 
cince Chirurgiceque Doctoris libentissime prcveximus, eique omnia 
jura privilega et honor es ad istum quoquomodo pertinentia, dedimus 
it concessimus. 



BY-LAWS. 369 

In cujtis ret major em fidem et pUnius testimonium, sigillo hujusce 
Societatis, Proesidisque et Scrivas chirograpkis hocce Diploma 
muniendum curavimus. 

Datum , die anno 

Domini ' et Societatis. 

PRiESES 



v±\ 



\ Socii. 

SCRIRA. 

CHAPTER XVII. 

AMENDMENTS. 

These by-laws may be amended at any annual meeting by a tv\o- 
thirds vote of the house of delegates, provided, that at least fifty 
members are present ; and provided further, that the amendment 
shall have been twice read in open meeting and laid upon the table 
for one day. 



370 medical society of new jersey. 

Report of Standing Committee. 

Mr. President : 

In response to short circular- letters of inquiry sent to the 
reporters, replies, more or less extensive, have been received 
from all of the District Societies with the exception of Hudson, 
Monmouth, Passaic and Union. All the societies reporting mention 
the favorable improvement in the attendance, in the interest manifested 
by contributions and discussions. Essex reports the largest additions, 
numerically, to its roster, twenty-one members having been added 
during the year. A plan is under consideration to increase the num- 
ber of meetings, for the reason, as stated by the reporter, "that we 
begin to realize that a vast amount of material and experience has 
been lost by our neglect." Camden has added fourteen, Mercer 
ten, while smaller numbers have been added in some of the counties 
whose population is not so numerous. Sussex reports but one meet- 
ing held during the year, offering as an excuse that the territory 
covered and the distance to be traveled render more frequent meeting 
difficult. May we suggest that the fewer the meetings the less the 
interest. The seventy-ninth anniversary of this society occurs in 
May next, and preparations are to be made for the proper celebration 
of the event. One county reports ** the regular meetings have been 
held, nothing of special interest occurring ; no papers read nor cases 
reported." Probably if this society would follow the custom so 
universally in vogue, and invite addresses from specialists, it might 
have the effect of stirring up some latent enthusiasm. 

It is a source of felicitation that, after three years of disbandment. 
Ocean County makes application at this meeting for permission to 
establish a new district medical society in that county. 

At a meeting held in Woodbury, the Tri-County Medical Society, 
consisting of the medical societies of Cumberland, Gloucester and 
Salem was organized. The object of this society is the affiliation of 
the members of the societies mentioned, professionally and socially, 
and is in line with the plans proposed in the new By-Laws of the 
State Society now under consideration. 

As to diseases most prevalent, one most frequently mentioned is 
variola, but if the reports are sufficient to form a foundation for an 
opinion, it has not prevailed so extensively as popular belief would 
iiave it. Camden reports eighty-one cases treated in the municipal 



REPORT OF STANDING COMMITTEE. 37 1 

hospital with two deaths. Twenty-three cases occurred in New 
Brunswick, chiefly among the colored population. Somerset and Bur- 
lington have had a few cases, and it has prevailed to some extent in 
Millville and Vineland. Strict quarantine regulations and vaccina- 
tion have curtailed its spreading. A number of cases of lymph- 
adenitis have arisen in Hunterdon County, and this fact is seized upon 
by the anti-vaccinationists in support of their opposition, but investi- 
gation has not proven it to be so. 

Diphtheria is reported from many counties. New Brunswick has 
had two hundred and fifty-four cases with nine deaths. It also 
existed extensively in Phillipsburg. 

Pneumonia and epidemic influenza are occasionally mentioned, but 
certainly not to the extent of former years ; either other diseases have 
supplanted them or the epidemics of variola have detracted from their 
importance. 

Typhoid fever has existed more or less extensively. During the 
height of the season at Atlantic City, in August, 1902, a very serious 
epidemic occurred there. A painstaking and exhaustive investigation 
was made by a committee of Atlantic City physicians, and the source 
of infection was traced to the oysters and clams brought from the 
waters between Beach Thoroughfare and the ocean, where it is the 
custom to " lay out " for twenty-four to forty-eight hours. The sale 
of these articles of diet taken from those waters was strictly prohib- 
ited and the epidemic ceased. A very interesting account of this 
investigation has been published in the Philadelphia Medical Record, 
but as a matter of history of our Society and State, should also 
appear in our Transactions. Camden, city and county, usually 
reporting so many cases of typhoid, states that but forty-two cases 
have occurred. 

With so many excellent hospitals in our State, we wish much more 
definite information were furnished the Society, but, as it is, reports 
are seldom received from them. The Mercer Hospital, of Trenton, has 
been enlarged recently, and now has a capacity for one hundred beds. 
Repairs and additions are now in progress at St. Francis', Trenton, 
which when completed will cost |6o,ooo. The Newark City Hospital 
has taken a step to increase its usefulness by appointing Dr. Charles 
Teeter, as pathologist. It is the expectation of the profession of 
Newark to establish a medical library in connection with the public 
library of that city. 



372 MEDICAL SOCIETY OF NEW JERSEY. 

A prosperous year is reported for the William Pierson Medical 
Library at Orange. The medical library in Trenton, so recently 
established, has added during the year two hundred volumes, making 
a total of seven hundred on its shelves, with a regular subscription to 
twelve journals. Frequently lectures on medical and scientific 
subjects are delivered before the association. 

The following papers have been received, with a request for publi- 
cation in the Transactions : 

From Bergen County — •• The Imperfect Development of Children, 
Especially Girls, between the Ages of Twelve and Fourteen," by Dr. 
Gill Wylie. " Adenoids and Hypertrophied Tonsils," by Dr. F. S. 
Hallett. 

From Camden — " The Effects of the Scarcity of Anthracite Coal 
and the Use of Its Substitutes upon the Public Health," by Dr. Daniel 
Strock. 

The address of the President of the society. 

From Salem — " The Vicissitudes of Doctor's Life," by Dr. E. E. 
Degroft. 

A word in passing as to the publication of papers in the Transac- 
tions. This Society has repeatedly ordered that papers which have 
previously appeared in public print were not entitled to recognition in 
the Transactions, nor can papers forwarded by societies, and having 
been read before them, appear in the Transactions, unless of special 
merit. This decision rests with each member of the Committee on 
Publication, to whom is assigned his share of the reports and papers 
sent to chairman of the Standing Committee for criticism and revision. 

The profession of Atlantic City have taken legal action against 
one *• Dr." H. Walter, who is alleged to be issuing diplomas from the 
school of Mechano-Neural Therapy without being legally licensed to 
do so. The case is expected to come before the September term of 
court. 

The inroad to our ranks made by death have been greater than in 
1902. From our numbers the following have been taken : 

Atlantic County — Theophilus H. Boysen. Born, Rigarsville, O.. 
Jan. 14, 1854; died, Egg Harbor City, March 12, 1903. 

Bergen County— A. L. Vandewater. 

Burlington — W. L. Martin. Born, Chester Co., Pa., Jan. 22, 1827 ; 
died, Rancocas, Jan. 22d, 1903. 

Camden — James M. Ridge. Born, Bucks Co., Pa., 1826; died, 
Camden, Jan. 30, 1903. 



. REPORT OF STANDING COMMITTEE. 373 

Cape May — Walter S. Learning. Born, Seaville, March 4, 1854; 
died, Cape May, March 29, 1903. Isaac M. Downs. Born, Berlin, 
Dec. 5, 1841 ; died. Cape May Court House, March i, 1903. 

Cumberland — Joseph Sheppard. Born, Bridgeton, June 28, 1823 ; 
died, Bridgeton. October 23, 1902. 

Essex— Frederick William Thum. Born, Servia, April 24, 1865 ; 
died, Newark, June 27, 1902. Henry M. Smith. Born, Meredith, 
N. Y., Feb. 3, 1847; died. South Orange, Nov. 28, 1902. Arthur 
Ward. Born, Belleville. Dec. 22, 1823; died, Newark, July 6, 1902. 
Robert Morris Sutphen. Born, Plainsboro, April 2, 18 19; died, 
Newark, Sept. 2, 1902. 

Mercer— William D. Struble. Born, Branchville, Aug. 19, i860; 
died, August 28, 1902. 

Middlesex— Nicholas Williamson. Born, March 9, 1845; died, 
August 15, 1902. 

Sussex— Carlos Allen. Bom. Huntingdon, Sept. 18, 18 14; died, 
Vernon, Feb. 19, 1903. Sidney E. Strahley. Born. Huntsville, Sept. 
28, 1861 ; died, Newton, April 15, 1903. 

Appropriate obituaries accompany most of these notices. 
Respectfully submitted, 

H. W. Elmer, Chairman. 



ADDENDUM 



TO 



REPORT OF STANDING COMMITTEE. 



fin Mt^novimn. 



THEOPHILUS H. BOYSEN, M.D., 

Born January 14, 1854. 
Died March 12, 1903. 



ALBERTUS LYMEN VANDEWATER, M. D., 

Born 1850. 
Died March 2, 1903. 



W. L. MARTIN, M.D., 

Born February 19, 1827. 
Died January 22, 1903. 



JAMES M. RIDGE, M.D., 

Bom 1826. 
Died January 30, 1903. 



WALTER S. LEAMING, M.D., 

Born March 4. 1854. 
Died May 29, 1903. 



fin Mtmoxiam. 



ISAAC M. DOWNS, M.D.. 

Born December 5, 1841. 
Died March i. 1903. 



JOSEPH SHEPPARD, M.D., 

Born June 28. 1823. 
Died October 23, 1902. 



FREDERICK WILLIAM THUM, M.D.. 

Born April 24, 1865. 
Died June 27, 1902. 



HENRY M. SMITH, M.D.. 

Born February 3. 1847. 
Died November 28, 1902. 



ARTHUR WARD, M.D., 

Born December 23. 1823. 
Died J\ily 6, 1902. 



firt Mtmoviam. 



ROBERT MORRIS SUTPHEN, M.D., 

Born April 2, 1819. 
Died September 2. 1902. 



WILLIAM D. STRUBLE, M.D., 

Born August 19, i860. 
Died August 28, 1902. 



NICHOLAS WILLIAMSON, M.D., 

Born March 9, 1845. 
Died August 15, 1902. 



CARLOS ALLEN, M.D., 

Bom September 18, 18 14. 
Died February 19, 1903. 



SIDNEY B. STRAHLEY, M.D., 

Born September 28, 1861. 
Died April 15, 1903. 



OBITUARIES 



THEOPHILUS HENRY BOYSEN, M.D. 

Dr. Theophilus Henry Boysen was born January 14, 1854, at 
Rigarsville, Tuscurawas Co., Ohio, and died at Egg Harbor City, 
N. J., March 12, 1903, from valvular heart trouble. His father, Dr. 
Otto Boysen, practiced his profession for nearly 17 years at Rigarsville, 
when the family moved to Buffalo, N. Y. Theophilus later entered 
the medical department of the University of Buffalo, from which 
institution he graduated in 1874. He practiced his profession for 
two years at this place, when he removed to Egg Harbor City, N. J., 
where, through his energies and ability, he soon secured a large and 
lucrative practice. Dr. Boysen was also an active worker for the 
welfare of the town. In 1878 he was elected school trustee. In 1879 
coroner of the county, serving three years, and two terms as school 
superintendent. In 1884 was elected mayor, serving three years in 
succession, and again in 1891 for a term of three years. Dr. Boysen 
was one of the charter members of the Atlantic County Medical 
Society, and was chosen its secretary ; he subsequently became its 
president, and in 1896 a permanent delegate to the State Medical 
Society. He was also a member of the American Medical Asso- 
ciation. 

Dr. Boyson was for many years the president of the Aurora Singing 
Society, the first of its kind organized in South Jersey. He was also 
secretary of the Egg Harbor Building and Loan Association, and 
was one of the city's most progressive citizens. 



ALBERTUS LYMEN VANDEWATER. M.D. 

After a brief illness, the fatal termination of which will be lamented 
by all who knew him. Dr. Albertus Lymen Vandewater, medical 
director of the Provident Savings Life Assurance Society, died of 
pneumonia on March 2d, 1903. Dr. Vandewater's successful career 
in the medical branch of the life insurance business, which extended 
over a period of many years, won for him the high esteem of his 
many friends. 



380 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Vandcwater was born in Brooklyn, N. Y., in 1850. He was a 
graduate of the Bellevue Hospital Medical College, and served three 
and a half years as house surgeon of the old Center Street Hospital. 
He was later physician to the Brooklyn Bridge Construction Company. 

Beginning in 1878, Dr. Vandewater practiced his profession with 
great success in Bay Shore, L. I., for about eight years. 

Becoming interested in life insurance, he then took up that work 
as medical inspector for the Equitable. Later he was made assistant 
medical director of that company. After serving some years in this 
capacity, and displaying unusual aptitude for this line of work, he 
became medical director of the Provident Savings, which position be 
held at the time of his death. 

In the discharge of his official duties. Dr. Vandewater possessed a 
high order of talent and ability which, joined with his pleasing 
personality, secured and retained for him, to a marked degree, the 
regard of the men in the lield. 

In addition to his successful life insurance career, he continued his 
interest in business and general medicine, serving for years on th^ 
staff of the Hackensack Hospital. He was successively vice-president 
and president of the Bergen County Medical Society of New Jersey, 
director of the First National Bank of Spring Valley, and a Free 
Mason of high order in Bergen County Lodge. No. 40, R. A. M. 

Dr. Vandewater is survived by a widow, a son and a daughter. Dr. 
Vandewater was a man whose loss will be keenly felt. 



WILLIAM L. MARTIN, M.D. 

BY NEWLIN STOKES, M.D. 

William M. Martin, M. D., died at his home in Rancocas, 
N. J., January 22d, 1903. aged 76 years. 

Born in Chester Co., Pa., he received a county school education 
until his fourteenth year, when he finished his classical studies at the 
Unionville Academy, Chester Co. 

He graduated at the Jefferson Medical College in 1852: While a 
student under the care and advice of his preceptor. Dr. Murphy, he 
attended many of the poor of his neighborhood. 

Immediately after graduating he settled in Rancocas, Burlington 
Co., N. J. Then commenced a long and useful career. He was a 



OBITUARIES. 381 

true born doctor of the old school — a typical country doctor ; genial, 
courteous, ever ready to do a favor, and withal most modest and 
unassuming ; a regular attendant of the meetings of the medical 
society, of which he early became a member ; an early advocate of 
asepsis and antisepsis, and believed in keeping up to modern stand- 
ards of practice. 

He was to the last an advocate of bleeding in acute pneumonia, a 
practice which some of us are probably too shy of. 

Dr. Martin practiced his profession faithfully and conscientiously, 
securing and maintaining to a marked degree the love and esteem of 
his patients. The emoluments of his business were to him secondary. 
He made but little profession of his religious belief, but those of us 
who know him best can testify to his unfaltering love and confidence 
in his Saviour, and we doubt not he has received the joyful summons 
of " Well done, good and faithful servant, enter thou into the joys of 
thy Lord." 



JAMES M. RIDGE, M.D. 

BY JOSEPH H. WILLS, M.D. 

Dr. James M. Ridge, of Camden, N. J., died on the 30th of January, 
19Q3, of Bright's disease of the kidneys. He had been previously a 
sufferer for a long time from diabetes. He was laid to rest in the 
Old Reed's Burying Ground, Tinicum Township, Bucks Co., Pa. 

He was born in Bucks Co., Pa., in 1826. His father was an intelli- 
gent, prosperous farmer of Tinicum township. James received his 
rudimentary education from him and was sent to the public schools. 
In 1847 he entered the boarding school at Bridgeton, Pa. He after- 
wards graduated from the medical department of the University of 
Pennsylvania in 1852. and began the practice of medicine. 

In 1856 he located in Camden, devoting himself to the practice of 
his profession and to scientific study and literature. He was a man 
of remarkable memory, staunch integrity, and never tired of work. 
He became a member of the Camden District Medical Society in 
1866. There was no subject of medical importance in which Dr. 
Ridge did not take a very active interest, and he was very aggressive 
in debate, demanding attention by the vehemence of his speech as 
well as by the force of argument. 



382 MEDICAL SOCIETY OF NEW JERSEY. 

He was called to fill positions of honor, such as President of the 
Board of Education, President of Camden City Medical Society, 
President of Camden District Medical Society, Representative to 
International Medical Congress held in Philadelphia, etc. 

As we saw him engaged in debate, many of us looked up to his 
tall, well-formed figure surmounted with white locks as a patriarch 
in medicine, for he practiced medicine over half a century. 



HON. WALTER S.LEAMING. M.D.. D.D.S. 

BY JAMES MECRAY, M.D., AND EUGENE WAY, M.D. 

It is no common chance that takes away a noble mind ; and it was 
a serious and severe blow to our whole county when, on March 29th. 
1903, it was unexpectedly announced in Cape May that Dr. Walter 
S. Leaming, the Postmaster of Cape May, was stricken by the hand 
of death. 

As the County Gazette well says, ** Dr. Leaming was in the very 
prime of life, and with mental power far in excess of the average, with a 
memory certainly second to none, with a warm heart that beat for 
other's woes, with a genial and agreeable address that always attracted 
strangers as well as friends, he was easily one of the most popular 
men in South Jersey." 

His father. Dr. Jonathan F. Leaming, selected as State Senator for 
the county of Cape May, was well nigh crushed beneath the weight of 
the loss of his first born, but still lives, at the ripe old age of eighty-one, 
at the Court House, in this county. Dr. Leaming passed through the 
public schools of the county, attending Mayville Academy, and 
studying for a time in New York City. He finally entered the employ 
of Edmund T. Davis, in the latter city, and was for a time assistant 
court stenographer. He graduated at the Pennsylvania Dental Col- 
lege in Philadelphia in the class of 1876, and in 1882 Dr. Leaming 
completed a course at the Jefferson Medical College, graduating as a 
doctor, with distinction. His first wife was Miss Mary H. Holmes, 
daughter of Hon. Richard C. Holmes, and in 1889, when he came to 
live at Cape May, he married as his second wife Rebecca Bennett, 
daughter of William Jackson Bennett, leaving three children by his 



OBITUARIES. 383 

two marriages. Besides being an able man in his chosen profession, 
he was a wise man as a politician and a statesman— perhaps the 
wisest of his generation in this county. 

As a political leader, he was quiet, but forceful, loved by his 
friends, but always retaining the good will of his political opponents. 
He was a modest man, and wisdom often credited to others in his 
party's counsels frequently had its origin in the brain of Dr. Learning. 
Above all, he was a Christian man, as well as an honest man, and the 
pastor of the Baptist church of which he was an honored member. 
Rev. Mr. Williams, told the writer of this " that when the last sum- 
mons came Dr. Learning met it with a true courage and faith of a 
Christian man." 

Dr. Leaming could have been re-elected readily the second time to 
the State Senate, as his father was, but he had weaned of the strife, the 
anxieties and the exigencies of political life. It was General William 
J. Sewell. then United States Senator for New Jersey, who said of 
Senator Walter S. Leaming : 

•' I have the warmest and deepest sentiments of friendship and 
affection for Senator Walter S. Leaming. His career of six years 
at Trenton as a public servant, three in the Senate and three in the 
House of Assembly, were eminently able and honorable throughout. 
His public character was marked by good faith and good sense ; he 
was a true man." 

Dr. Learning's funeral was the largest outpouring of sorrowing 
friends since the funeral of Richard S. Leaming at Dennisville some 
years ago. 

And the political and personal friends recall with great pleasure the 
just tribute to Dr. Leaming's character in Lewis's History of the First 
Congressional District of New Jersey. He says: "The common 
opinion^has for some time been that American politics were probably 
never so corrupt as at the present day ; that the affairs of the country 
arejin^the^hands of the professional politicians, who are working for 
their own interests, and not for the good of the majority; and it is such 
men as Dr. Leaming that restore the public confidence and renew 
the faith that we shall have wise legislation and just laws brought 
^boutjby^honorable men with pure political records and devoted to 
their^country's interests, and not to their own aggrandizement." 



384 MEDICAL SOCIETY OF NEW JERSEY. 

ISAAC M. DOWNS, M.D. 

Dr. Downs was born at Berlin, Camden Co., N. J., December 5th, 
1841. He was the son of James and Harriet S. Downs. While he 
was yet in his infancy his father moved to Tuckerton, N. J., where 
his boyhood days were spent. He attended the public school, and 
was noted for his devotion to study, rarely indulging in amusements 
with other children of his age, seeming to consider it almost a crime 
to waste time at play. This industrious pursuit of knowledge 
followed him through his whole life. He was a teacher in the public 
school for a time before entering college. 

He began the study of medicine at the age of fifteen years, under 
the guidance and instruction of Dr. Mason, of Tuckerton. After 
graduating in medicine he secured a position as surgeon in the Emory 
General Hospital, at Washington, D. C. 

Soon after the] close of the war he settled at Cape May Court 
House, N. J., where the remainder of his valuable life was spent in 
devotion to the needs of those who desired his professional services, 
sacrificing his health and comfort in order that he might lessen the 
suffering of others. 

He died from general paralysis, March i, 1903. his health having 
been gradually failing for about three years. 

Dr. Downs was a man of scholarly habits, fine attainments, and of 
strong convictions. He was an active member in the Methodist 
Church and for many years teacher of the Young Men's Bible Class. 

In politics he was always an active Republican. In the years 1884 
and 1890 he was elected to the office of coroner without solicitation 
on his part, serving the two terms of three years each with credit to 
himself and his constituents. 

He was an active and esteemed member of the Cape May County 
Medical Society, always taking a deep interest in the work and prog- 
ress of the medical profession. 



JOSEPH SHEPPARD, M.D. 

BY H. W. ELMER. * 

Dr. Sheppard, the son of the late Henry and Sarah Sheppard, was 
born in Bridgeton, N. J., June 28lh, 1823, and died October 23d, 1902. 
He received his preliminary education at the local schools, and subse- 



OBITUARIES. 385 

quently at Newark, Del. He began the reading of medicine under 
the late Dr. William Elmer, and after attending a three years' course 
at the University of Pennsylvania, graduated at that institution April, 
1849. After practicing, for a short time only, at May's Landing, he 
returned to Bridgeton, but was soon appointed to the position of 
assistant physician to the department for the insane at the Philadelphia 
Hospital, then called " Blockley Almshouse." This position he 
retained for one year, and was appointed a resident physician to the 
hospital proper. In 1863 he was appointed acting assistant surgeon 
of U. S. volunteers, and was assigned to the general hospital at 
Chestnut Hill, remaining in active duty till close of the war, when he 
resumed active practice in his native town. For ten years he was 
physician to the county almshouse and jail, performing his duties with 
great satisfaction, as evidenced by his renewed appointments. He 
was a member of the medical examining pension board for the lower 
counties of the State until a short time before his death, when failing 
health compelled him to resign. For twenty-eight years he served 
without interruption as Treasurer of the Cumberland County Medical 
Society. 

For many years he has been a consistent member of the Second 
Presbyterian Church of Bridgeton, faithful to his work and exceed- 
ingly conscientious in the full discharge of what he deemed to be his 
duty. By nature possessed of a retiring disposition, his failing health 
within the past few years has tended to withdraw him from partici- 
pation in public affairs, but Dr. Sheppard will always be regarded a& 
a man of strict integrity and honor. 



ARTHUR WARD, M.D. 

Arthur Ward was born at Belleville, N. J., Dec. 23d, 1 823, and died at 
Newark, N. J., July 6th, 1902. He was the son of Samuel L. Ward, M.D., 
for many years a practicing physician in Belleville. His mother was 
Caroline Bruen Ward. Arthur Ward was educated at Bacon Acad- 
emy, Colchester, Conn. After leaving the academy he entered Yale 
College, from which he received the degree of Bachelor of Arts in the 
class of 1844. Subsequently Yale conferred the Master's degree 
upon him. After graduation he took up the study of medicine under 
his father, and with the late Thomas Cock, M.D., of New York, who 

25 



386 MEDICAL SOCIETY OF NEW JERSEY. 

was one of the founders of The College of Physicians and Surgeons. 
He pursued his studies in the college, which, in 1847, conferred upon 
him the degree of Doctor in Medicine. Soon after he began practice 
in Newark. After a year here he removed to Belleville, where he 
remained until 1 865. Meanwhile his Newark practice became so large 
that he again removed to Newark. At the time of the establishment 
of the Hospital of St. Barnabas, he was made one of the attending staff. 
His connection with the hospital terminated only with his death. For 
several years he had been president of the medical board. The Essex 
District Medical Society also honored him. It 1868 he was president 
of this society. When the Medical Society of New Jersey created the 
office of permenent delegate. Dr. Ward was one of the six selected to 
represent this Society. He was a permanent delegate at the time of 
his death. He was also a member of the Medical and Surgical Society 
of Newark, and had been at one time its president. He was also a 
corresponding member of the Medical Society of Connecticut, and a 
life member of the New Jersey Historical Society. He was for many 
years an elder of the North Reformed Dutch Church of this city. 

In 1854 he married Anna C. Lee, daughter of Robert Lee. of 
Rah way. The death of Mrs. Ward was preceded by a long and 
harassing illness. Dr. Ward's care of her was marked by a tireless 
devotion ; hopeful when to others everything seemed hopeless. Her 
death broke him down, and three months later he followed her. 



FREDERICK WILLIAM THUM, M.D. 

Frederick William Thum was born in Servia April 24th, 1865, and 
received his elementary education in public schools at Frankfort-am- 
Main and Laubach, Germany. At the age of fifteen he came with 
his parents to this country. The family came directly to Newark, 
and here they established their home. In order to fit himself for the 
practice of pharmacy, young Thum entered the New York College of 
Pharmacy, and was graduated from that institution in 1885. In con- 
nection with his brother George, he founded a pharmaceutical estab- 
lishment in Elizabeth. New Jersey, in which project at the time of 
his death he was still interested. When the success of this enterprise 
was fairly assured, Thum matriculated at the College of Physicians 
and Surgeons, New York City, and in 1891 received the degree of 
doctor in medicine from Columbia University. He immediately began 



OBITUARIES. 387 

practicing in Newark, and attained a noteworthy position among the 
physicians of this city. He was a good student, painstaking and 
progressive. He was soon connected with the German Hospital, and 
was for several years president of the medical board. At the time of 
his death he was also one of the visiting physicians at St. Michael's 
Hospital. He was a member of many social organizations and of 
the Essex District Medical Society and the Practitioners' Club. He 
was also interested in politics, and in 1900 was nominated for the 
position of Commissioner of Public Works in Newark, but was unsuc- 
cessful at the polls. In November, 1896, he married Miss Paula 
Lorenz. A month before his death, he received a poison wound, 
while performing an operation. Septicaemia finally developed in a 
very virulent form, and on June 27th, 1902, he died. He was thirty- 
eight years old. 

HENRY MELVILLE SMITH, M.D. 

Henry Melville Smith was born at Meredith, N. Y., February 3, 
1847, and received his early education in and near Delhi, N. Y., after 
which he took up the study of medicine. In 1871 he was graduated 
a doctor in medicine at the College of Physicians and Surgeons, New 
York City. After several years of active work in his native State, he 
removed to Jersey City, N. J., where he built up a lucrative practice. 
In January, 1886 he was elected a member of the medical staff of 
Christ Hospital. Jersey City. Five years later he was transferred to 
the surgical staff. For several years he was president of the medical 
board. In 1898, as a consequence of overwork, he was compelled to 
sever his connection with the hospital and to give up for a time all 
professional work. He removed to South Orange as a means of 
recuperation. After two years of rest he was enabled again to take 
up his work in South Orange. He continued in practice until a few 
days before his death, which occurred November 28th, 1902, and was 
due to myocarditis. His body was interred at Delhi, N. Y. 



♦ROBERT MORRIS;SUTPHEN, M.D. 

Robert Morris Sutphen was born near Plainsboro, N. J., April 2d, 
1 8 19, and died at Newark, N. J., September 2, 1902. While he was 
quite young the family moved overland^ to Ontario, N. Y., when the 

* Carried on the rolls of the Society as Reuben M. Sutphen, M.D. 



388 MEDICAL SOCIETY OF NEW JERSEY. 

country was almost a wilderness. He attended the local school, and 
was afterward a student at Marion Seminary nearby. Reluming to New 
Jersey in 1845, he entered the office of Dr. John Voght. Freehold, as 
a medical student. After the necessary courses of lectures he was 
graduated in medicine, in 1847, from the medical department of the 
University of New York. He began the practice of his profession 
in the village of Walworth, Wayne Co.. N. Y. He was successful, 
and remained in this community for twenty years. In 1848 he 
married Virginia Morris at his old home, Plainsboro, N. J. In 1867 
he removed to Newark, N. J., and became associated in practice with 
Dr. George R. Kent. Until his last illness he continued at work ; 
fifty-four years of it — an unusual number. He was a very religious 
man, but his was a religion of cheerfulness, that helped him to bring 
comfort and hope into the sick-room. 



WILLIAM McDANOLDS STRUBLE, M.D. 

BY C. F. ADAMS, M.D., AND B. W. MCGALLIARD. M.D. 

The subject of this sketch was born in Branchville. Sussex Co.. 
N. J., in i860. He received his early education in the public schools 
of his native place and in the school of Dover, N. J. 

On the removing of the family to Trenton, N. J., he assisted his 
father in a grocery store. At this time, when about twenty-one years 
old, he took up the study of medicine under the preceptorship of Dr. 
Lyman Leavitt, later attending the medical department of the Univer- 
sity of Pennsylvania, from which he received the degree of M.D. in 
1885. 

His student days were marked at all times by close attention to his 
studies. It was his custom to recite page after page from his text- 
books to his preceptor, and by reason of his close attention to his 
work at the medical school he graduated as the first of his class. 

Soon after his graduation he was appointed City Physician, and 
during his service as assistant coroner's physician he extended his 
knowledge of anatomy and pathological conditions. 

In June, 1886, he was married to Rachel Holt. In 1897 he was 
appointed a member of the surgical staff of Mercer Hospital, which 
position he held to the time of his death. 



OBITUARIES. 389 

Through his efforts, largely, in the City Board of Health, an ordi- 
nance was established that required that the Health Officer be a 
physician, and efforts in the direction of improved care and attention 
of contagious disease cases resulted in the building of improved 
municipal buildings for the care of cases of contagious diseases. It was 
at this time, also, that the Board of Health began the consideration for 
the registration and control of tuberculosis cases, which resulted in 
an ordinance which regulated the control of these cases. He was 
President of the Board of Health at the time of his death, which 
occurred August 28th, 1902. 

He was one of four physicians who, in the face of considerable 
opposition, succeeded in securing the passage of a law, in the year 
1895, in the Stale Legislature, allowing the use of human dead bodies 
for the furtherance of anatomical and pathological studies, and in 
harmony with that law, helped to establish the Trenton Pathological 
Association. 

He was a persistent worker in his profession, administering to a 
large practice. He was devoted to the science and practice of medi- 
cine, working day and night, never resting — thus was " the silver cord 
loosed and the golden bowl broken, and the spirit returned to God 
who gave it. 



CARLOS ALLEN, M.U. 

BY H. D. VAN GAASBECK, M.D. 

Dr. Carlos Allen died at his home in Vernon, N. J., on Thursday, 
February 19, 1903. He was the eldest member of the Sussex County 
Medical Society, having joined it April, 1848. He was born at 
Huntington, Vt., September 18, 1814. being in his 89th year at the 
time of his death. He was educated at the academies of Richmond 
and Williston, Vt. He graduated from the medical department of 
Dartmouth College in November, 1837. He practiced his profession 
for the next five years at Richmond, Vt. He then removed to what 
was formerly known as Deckertown, where he practiced until 1846, 
when he removed to Vernon, where he practiced until old age and 
increasing infirmities prevented. 

He was a man of culture and refinement, and kept well in touch 
with the advances made in his profession. He was genial and affable 



390 MEDICAL SOCIETY OF NEW JERSEY. 

and well beloved by all who came in contact with him. In 1860 he 
published a map of Sussex County, which has been the accepted 
authority as a map up to the present time. In 1880 he was elected 
president of the Sussex County Medical Society. He was twice 
married, his first wife being Miss Arvilla Browning, of Richmond, 
Vt. She died in 1867. His second wife was Miss Susan Simonson, 
daughter of Major William Simonson, of Vernon, N. J. He is sur- 
vived by two children, Arvilla, who resided athome, and who tenderly 
nursed and cared for him in his declining years, and a son, Irvin, who 
resides in Glenette, Florida. Dr. Allen had been in feeble health for 
a number of years before his death, and consequently did not prac- 
tice his profession, but during his prime was a successful and able 
practitioner. 



SIDNEY B. STRAHLEY, M.D. 

BY SHEPARD VOORHEES, M.D. 

Dr. Sidney B. Strahley, of Newton, N. J., died April 15, 1903, of 
tuberculosis of the bladder after five and a half years of painful illness. 
He was born at Huntsville, Sussex County, N. ]., September 28, 1861. 
He received his early education in the schools of the county, and 
afterward taught school for three years and spent his vacations and 
leisure hours reading medicine under the direction of the late Dr. 
John Miller, of Andover. N. J. He attended lectures at the College 
of Physicians and Surgeons, Baltimore, Md., and graduated with the 
class of 1887. He located in Andover, being associated in practice at 
first with his former preceptor, Dr. Miller. By close application to 
his work, allowing nothing to come between him and his patients, 
and by his kindly ways, he soon succeeded in building up a large 
practice, and he was highly esteemed by the community. 

In the autumn of 1897 he was forced, because of failing health, to 
give up his medical labors. He went with his family to southern 
California, but the following spring, finding he had not received ben- 
efit by the change, he returned to his native town and rested during 
the summer, and the next winter tried the Indian River region of 
Florida. Here he improved so much that in the spring of 1899 he 
came to Newton, the county seat of his native county, and opened an 
office, to return South the next winter. He came back to Newton in 



OBITUARIES. 391 

the spring of 1900 much benefited in health, and entered actively in 
practice ; but after a few months of such labor he was again forced 
to give up work, and he went back for the third time to Florida in 
the autumn of 190 1, to return in the spring unimproved and to 
remain confined to his bed until death came as a relief after a year of 
intense suffering. Dr Strahley was a faithful, conscientious physician, 
possessed of a cheerful disposition, had a fondness for humorous 
anecdotes, and could tell them well. He was a man greatly attached 
to his home, and always had his wife and little daughter accompany 
him in his travels. 

He was a graduate of the Chautauqua Literary and Scientific Circle, 
a work in which he took great interest. In 1894 he took a course in 
the New York Post Graduate Medical School. Besides being a 
member of the County and State medical societies, he was a member 
of the Tri-County Medical Society, and for several years of the 
American Medical Association. He was a life member of the New 
Jersey Historical Society. He was a consistent member of the 
Methodist Episcopal Church, and from his early youth took an active 
part in religious work. 

He married in 1889, Susie V., daughter of Marshall S. Hibler, of 
Huntsville, N. J. The widow and their only child, Elva E., a girl of 
nine years, survive him. 



REPORTS OF DISTRICT SOCIETIES. 



ATLANTIC COUNTY. 

To the Chair Man of the Standing Committee^ etc.: 

The District Society has held its regular meetings throughout the year. 
These meetings were characterized by the usual average attendance 
and slightly more enthusiasm evidenced than heretofore. Seven new 
members were added to the roll during the past year. The society 
lost two of its members during the year — one through removal, and 
death claiming one of our oldest and most ardent workers. Dr. 
Theophilus H. Boysen (See obituary notice). The county and city 
are at present unusually free from contagious diseases. During 
January and February there were a number of cases of influenza, but 
no epidemics reported. During the height of the season (August), 
1902, a number of cases of typhoid were reported, which led to an 
investigation by a committee of local physicians, the following being 
a full report : 

Report on Typhoid Fever at Atlantic City. 

To the Atlantic City Academy of Medicine : 

Gentlemen— At your last regular meeting, on September 19. 1902, 
attention was called to the prevalence of an increased number of cases 
of typhoid fever in this city, and to the adverse reports from cases in 
other cities, said to have originated here ; also to several publications 
that indirectly reflected on sanitary conditions here. You appointed 
a committee to take up this matter systematically and investigate every 
possible point from which typhoid or other diseased conditions might 
emanate, and authorized the employment of such sanitary experts as 
might be of assistance. We beg to make the following report : 
water supply. 

We personally investigated the distribution, pumpage. reservoir and 
accessories, and found no possible present source of contamination of 
the supply. The water-supply is drawn largely from a series of 
driven artesian, self-flowing wells in an almost uninhabited watershed. 
These wells tap a subterranean stream of the purest fresh, clear water 
that can be found, and there can be no possible contamination from 



394 MEDICAL SOCIETY OF NEW JERSEY. 

this source. This water is delivered into a reservoir of pure sand and 
gravel, and pumped direct from this point to the city. The second 
source of supply is a small lake or pond fed largely by springs and 
small streams coming from the wild, natural cedar lowlands, and two 
miles from the pumping station, to which it is conducted through an 
open artificial canal. Our Water Commissioners are planning a closed 
wooden conduit to replace this open canal. This water, like all cedar 
water, has a slight brownish color, due to coloring matter from cedar 
roots in the lake, but this is not injurious. 

We are convinced that no typhoid fever has emanated from this 
source. There is also a reserve artesian system of deep wells on the 
island in the city from which is taken as pure a supply of water as 
can be found in the world. 

SEWERAGE SYSTEM. 

The sewers are built on the West system ; all sewage flows to a 
common pumping station, and is pumped in large pipes across the 
saU marshes, small streams, Penrose Canal and Clam Thoroughfare, 
into Beach Thoroughfare, at a point about two miles from the center 
of the city. Beach Thoroughfare is a Government highway of ocean 
water and carries large ocean-going sailing vessels. The sewage 
pumped into it is infinitesimal in comparison to this body of water, 
and. by the time it flows through its channel to the sea, it is almost 
nil. We are informed thai, during the past summer^ owing to a 
break in this disposal pipe, almost the entire sewage of the city passed 
directly into Penrose's Canal, and flowed through this with the ebb 
and flow of the tide into the Thoroughfare, Penrose's Canal is an 
artificial waterway carrying a comparatively small proportion of 
tide water. It begins near the railway entrance to Atlantic City and 
extends about a mile or less to Clam Thoroughfare, and this in turn 
to another point on Beach Thoroughfare near the regular sewage 
outlet. 

We know of two authentic cases of typhoid fever that could be 
traced positively to sources outside of Atlantic City, from which all 
excreta was thrown into the sewer for four weeks in one case and 
ten days in the other, with no disinfection whatever. Other cases 
may have done the same. Sewage contaminated with typhoid stools, 
passed directly into Penrose's Canal and contaminated this water, 
rendering it dangerous for use for any purpose. We also find another 
point, known as Gardner's Basin, in the city limits, where all the 



REPORTS OF DISTRICT SOCIETIES. 395 

sewage of that immediate district passed direct for many years until 
sewers were laid, and at present these waters are contaminated with the 
excreta thrown from boats, as well as from two properties not yet con- 
nected with the sewer, rendering this water unsafe for use. We find 
in these infected waters the strongest and most positive circumstan- 
tial evidence pointing to the source of the present trouble. 

OYSTER SUPPLY. 

The so-called " Absecon Salts " are grown in beds situated near 
Grassy Bay, where the tide-water of our inlet and Brigantine Inlet 
divide, and far from sewage contamination. A salt-water oyster is 
rather bitter and *' thin " when first taken, and must be " fattened," 
" freshened '* or '• fed " before it is " prime." This " fattening " pro- 
cess consists in putting the oyster in a mixture of fresh and salt' water 
in certain proportions. They remain there for 24 to 48 hours, and 
are then ready for delivery, greatly increased in size from their 
** drink." During ten months of the year the " fattening " process is 
done near Absecon, where the waters are pure and safe, but in July, 
August and part of September the largest dealers have been 
" fattening " their oysters in waters taken from Gardner's Basin and 
at the city end of Penrose's Canal, the points already specified as 
infected with sewage. The largest individual dealer had his " crib ' ' 
in the mouth of Penrose's Canal, and this dealer, as well as others, 
unknowingly and thoughtlessly, supplied the markets with sewage-fed 
oysters. These oysters, when eaten raw, exposed one to diarrhoea, 
cramps, dysenteries and, possibly, typhoid fever. We find on investi- 
gation that all of the typhoid patients, with few exceptions, had 
indulged freely in these raw oysters and undoubtedly contracted their 
disease from them. 

Clams taken from these sewage-infected waters are usually cooked ; 
but, when eaten raw, expose to similar troubles. 

Other food and milk supplies have been considered, but, as the 
cases are not localized to the delivery of any dealer, are found not at 
fault. Several of these typhoid cases have been traced to sources 
outside of our city, while others, who have not eaten oysters raw, 
may have been exposed by some direct or indirect contamination 
away from this city. With 'typhoid fever epidemic in our leading 
cities, we may fully expect to hear of many cases wrongfully attrib- 
uted to this city, on the strength of a few days' stay here. In several 
instances, with cottage and transient guests, it was their daily custom 



396 MEDICAL SOCIETY OF NEW JERSEY. 

to spend the day at business in our nearby cities, eat their dinners there 
and return in the evening, and then attribute their typhoid to Atlantic 
City. The possibilities in these cases, in which the raw oysters have 
not been eaten, are strongly in favor of out-of-town infection. 

Believing as we do that we have located this entire trouble, these 
facts were presented to the Board of Health of Atlantic City, by the 
committee in person, and it was ordered by the Board of Health that 
in the future no oysters fattened in the waters between Beach Thor- 
oughfare and the ocean, and no clams taken from Beach Thorough- 
fare, or the waters between it and the ocean, should be sold or 
delivered within the corporate limits of Atlantic City under the 
penalty of a heavy fine. The Board of Health also resolved to notify 
the local boards of health in the oyster " fattening" districts with a 
view to properly regulating and safeguarding the output. All dealers 
have been notified of this ruling, and it is now in full force. We 
consider our oyster supply now safe. 

(Signed) B. C. Pennington. Pres, 

VV. Blair Stewart, Sec. 
W. M. Pollard. 
Philip Marvel. 
J. Francis De Silvrr. 

Committee. 



University of Pennsylvania, 
Laboratory of Hygiene, 

Philadelphia, Oct. 20, 1902. 

Dr. W. Blair Stewart, 

N. E. cor. Pacific and North Carolina Aves., 
Atlantic City, N. J. 

My Dear Dr. Stewart : 

I have read your report carefully, and after examination of all 
available evidence on the subject and personal inspection of your 
water-supply, sewage-disposal system and the oyster-fattening plants 
under suspicion, am convinced that the opinion expressed by your 
committee is correct. I am glad, therefore, to be able fully to 
endorse all that you have said in your report, and particularly that 
part of your report referring to the oysters as the probable source of 



REPORTS OF DISTRICT SOCIETIES. 397 

the infection during the summer. I do not believe that the evidence 
we have gotten together on the matter justifies any other conclusion. 

Very truly yours, 
(Signed) A. C. Abbott, M.D., 

Professor of Hygiene and Bacteriology, 
University of Pennsylvania, 

I coincide with the conclusions above set forth. 

(Signed) Henry Leffmann. 

Our Committee on Illegal Practitioners was instructed to bring 
immediate action against ** Dr." H. Walter, who is supposed to be 
practicing medicine in Atlantic City without complying with the legal 
requirements. He claims to be practicing a system of Mechano- 
Neural Therapy, and is conducting a school or college, which is said 
to be authorized by a charter received from the State of New Jersey. 
The committee employed counsel, had Dr. Walter arrested and 
brought into the Recorder's Court. He waived a hearing and 
will come before the September term of court. The committee will 
take action against others practicing in Atlantic County and Atlantic 
City without legal registration. 

A. Burton Shimer, Reporter, 



BERGEN COUNTY. 

To the Chairman of the Standing Committee : 

The District Medical Society of the County of Bergen has held its 
regular quarterly meetings throughout the year, and I am pleased to 
report that there has been a larger attendance, and greater interest 
has been displayed among the members than in any previous year. 
The annual meeting, which was held at Hackensack April 14th, was 
made particularly interesting by Dr. Gill Wylie, of New York, 
who addressed the society on ** Imperfect Development of Children, 
Especially Girls, between the Ages of Twelve and Fourteen Years." 
A copy of this address I have already forwarded to your committee, 
and it will no doubt receive a place in the Transactions of the State 
Society. Among other essays read during the year, and in fact the 
only other essay which has come to my hands, was one by Dr. Frederick 
S. Hallett, of Hackensack, on "Adenoids and Hypertrophied Tonsils," 
which has also been forwarded to you to appear as a separate essay. 



398 MEDICAL SOCIETY OF NEW JERSEY. 

During the year five new names have been added to our member- 
ship list. We have but one death to record, that of Dr. A. L. 
Vandewater, of Hackensack, whose obituary will appear in its proper 
place. 

Most of the members report la grippe and pneumonia prevailing 
throughout the county during the winter and spring months. A 
number of cases of diphtheria appeared in Hackensack and Engle- 
wood during the early spring. Parotitis has prevailed epidemically 
throughout the county, but we have been remarkably free from any 
serious epidemics. Dr. Parsell, Closter, and Dr. Currie, Englewood, 
report epidemics of pertussis in both places. Dr. Parsell reports 
three cases of typhoid fever occurring in his practice, and Dr. Currie 
typhoid and malarial fevers throughout the year. Dr. Parsell also 
reports a case of tetanus, caused by stepping on a rusty nail. The 
patient died on the fourth day. although large injections of tetanus 
antitoxin were used. 

The advancement made in our society during the past year is evi- 
denced by the increased interest of the members as well as by the 
increase in our membership roll, and it is gratifying to report that this 
has been the most successful year that the society has yet known, and 
I sincerely hope that the advancement and interest the members are 
showing will continue to grow until our society shall be second to 

none in the State. 

J. W. Proctor, M.D., Reporter. 

Englewood, N. J., June 9th, 1903. 

Adenoids and Hypertrophied Tonsils, 
by frederick s. hallett, m.d.. hackensack, n. j. 

So much has been said and written upon the subjects of hypertro- 
phied tonsils and adenoids by the nose and throat men that there is 
surely nothing new for the general practitioner to say. My excuse 
for preparing this brief and very incomplete paper is because I believe 
that, in spite of all that has been said, we are inclined to neglect these 
cases, especially in very young children. 

The two conditions are so frequently associated in children that it 
seems to me quite proper to consider them conjointly. The diagnosis 
is usually not difficut, especially when the hypertrophies are extensive. 

The mother will give us a history of the child sleeping with 
open mouth and snoring ; it is very restless at night ; has one cold 
after another, with profuse discharge from the nose ; the child has 



REPORTS OF DISTRICT SOCIETIES. 399 

difficulty in nursing ; it will frequently drop the nipple to get air. 
Earache is a prominent symptom, followed by discharge of pus 
from the ear. The child is apt to be delicate and below par in devel- 
opment, and mentally deficient as well. It has a stupid facial expres- 
sion with heavy eyes. The nose is broad with mouth half open, and 
the voice is muffled and nasal in character. The upper lip is very often 
excoriated by irritation of the more or less constant discharge from 
the nose. Nose-bleed is a frequent symptom. 

Such a history as the above makes the diagnosis almost positive. 
These children have capricious appetites, indigestion with vomiting 
is the rule. They are subject to various nervous reflexes, as nocturnal 
enuresis, headache, cough, stammering and stuttering. 

Upon examining the throat the hypertrophied tonsils are easily 
recognized. In cases where the pillars of the fauces are adherent to 
the tonsils the hypertrophy may seem less marked than it really is. 
It is not so easy to recognize the adenoids. It requires an experienced 
hand to examine the naso-pharynx with a mirror in a very young 
child. I have never been able to do it. 

When the throat is exposed there is very often seen an egg-like 
mass of mucus hanging down from the naso-pharynx, and when pres- 
ent, it is said to be quite diagnostic. The diagnosis is confirmed by 
digital examination. For this the child is held on the mother's knee, 
or, if old enough, he may be allowed to stand. The examiner stands 
behind the patient encircling the head and neck with his left hand, 
pressing the child's head against his left side. The mother can hold 
the child's hands. The mouth is now opened, and can be kept open 
by putting the handle of a tongue depressor between the teeth, or by 
pressing the cheek between the teeth with the left hand. The index 
finger of the right hand is now quickly carried behind the soft palate 
and up into the naso-pharyngeal cavity, and here a soft mass will be 
felt, said to resemble that of a bunch of worms. When the finger is 
withdrawn a little blood usually comes with it, which does not happen 
when the naso-pharynx is normal. 

Adenoids might be mistaken for tumors but these growths are not 
often found in young children. In those cases where the adenoids 
and tonsils are large, with pronounced symptons, all authorities agree 
that they should be removed at once. If the hypertrophies are small 
and the nasal obstruction not marked, it may be good treatment to 
leave them alone, as there is a tendency for them to disappear at 
the age of puberty. 



40O MEDICAL SOCIETY OF NEW JERSEY. 

The treatment of these cases is absolute removal by cutting 
instruments. The removal of the adenoids by the finger is not 
thorough as a rule. If the operation is complete, there is little 
likelihood of the hypertrophies returning. 

We should not delay in advising operation in these cases. The 
child's hearing, development and general health may become hope- 
lessly impaired. These children are especially subject to the diseases 
of childhood from the already lowered vitality. The diseased tonsil 
is most favorable soil for diphtheria, scarlet fever and other infectious 
diseases. 

The contra-indications to operative treatment are ha^mophillia and 
inability to bear a general anaesthetic. If acute otitis media exists, 
there may be another attack following the operation, but this is likely 
to occur anyway, even if the adenoids are allowed to remain. 

In these young children the combined operation is done under 
general anaethesia. The choice of anaesthetic is left to the operator ; 
ether is undoubtedly the least dangerous. 

The child is placed in the recumbent position and when well under, 
a mouth gag is placed into position. The patient is now pulled 
forward, so that the head hangs over the table supported by the 
assistant ; the operator stands facing his patient on the left side of 
the table. A suitable size tonsillotome is selected, one that will fit 
nicely over the tonsil ; the tongue is held down by a tongue depressor, 
or better the finger, so that the throat can be brought into full view. 
If there are any adhesions between the pillars and tonsils, they are 
quickly broken up and the tonsils removed. It is best to take the 
smaller first, in cases where both are to be removed, because after 
the mouth fills up with blood it is not so easy to get at the smaller one. 

After the tonsils are removed, the head is turned to one side and 
the blood allowed to run out of the mouth. The index finger of the 
right hand is now introduced into the naso-pharynx and the location 
and extent of the adenoids noted. The Loewenberg forceps is inserted 
(closed) behind the soft palate and up into the naso-pharynx. One 
must observe in which direction the handles of the forceps Jie. They 
must be kept in the median line. If rotated to the left there is danger 
of grasping the eustachian eminences, or if the handles are lifted too 
near the upper jaw, the adenoid tissue may be missed in the grasp of 
the forceps. If the handles are brought down too near the lower 
jaw there is danger of grasping the posterior portion of the septum* 



REPORTS OF DISTRICT SOCIETIES. 4OI 

When the forceps are in position they are widely opened and closed. 
A slight rocking motion from side to side will serve to tear the 
tissue away. 

The forceps may be introduced a second time if there is much 
adenoid tissue remaining. 

The operation is completed with the curette. This is passed into 
the naso-pharynx with the handle depressed, so that the cutting blade 
reaches the roof of the naso-pharynx. Firm pressure is now made 
upon the handle and the cutting surface sweeps over the upper and 
posterior wall of the cavity. This sweep is made in the median line. 
A second sweep is made with the curette carried up as before. In 
the downward sweep, lateral pressure is made, the curette passing 
behind the eustachian eminences. A like sweep is made on the 
opposite side. 

With a little experience, one application with the forceps and the 
three sweeps with the curette will remove all the hypertrophied tissue. 
The whole operation should not take more than two to five minutes. 

The child is now drawn back on the table and the bleeding usually 
ceases. If it should continue the naso-pharynx can be packed with 
cotton, saturated with strong sol. tannic acid. Applications of the 
same solution can be made to the tonsillar surfaces. Suprarenal 
capsules may be used either in solution or the dry extract. 

The general treatment of hemorrhage is the same as in other cases. 
The after-treatment consists in keeping the patient in bed until all 
danger of hemorrhage has passed. During the winter months it is 
well to keep the child indoors for a few days until the naso-pharyngral 
congestion subsides, to prevent middle ear trouble. The diet should 
be fluid until deglutition becomes easy ; washing out the nose should 
be avoided unless septic symptoms arise. There is more danger 
from middle ear trouble from antiseptic douching following this 
operation than if the parts are left alone. Tonics may be given after 
the first few days. 

If the child continues to breathe through the mouth, as is often the 
case, he should be instructed to keep the mouth closed, and at night 
a handkerchief may be tied under the chin. 

The method of treatment which I have roughly outlined is the one 
followed by Dr. C. G. Coakley, of New York City. I had the pleasure 
of assisting him in his clinic for a time, and saw the excellent results 
obtained. 



402 MEDICAL SOCIETY OF NEW JERSEY. 

BURLINGTON COUNTY. 

To the Chairman of the Standing Commit tee ^ etc. : 

Inasmuch as only four of our members have made any report of 
medical affairs in their vicinity during the past year, your Reporter is 
forced to conclude that the following note from Dr. Marcy, of 
Riverton. represents conditions prevalent through the county. " The 
past year has been remarkable only for mediocrity in my practice — 
nothing unusual, no particular types of disease prevalent.** He notes 
an unusual number of cases of parotitis in adults. Dr. Shipps» of 
Bordentown, reports thirty-four cases of typhoid fever in April and 
May, 1902, and nineteen during the summer months; also five cases 
of smallpox in April and May» 1903. None previously vaccinated. 
In the typhoid cases the mortality vsras low. not exceeding 5 
per cent. Of fifty-three cases, nine had as a complication venous 
thrombosis, involving the left thigh only in seven and both extremities 
in two. In one case, a young male, sixteen years of age, insane delu- 
sions were noted at the end of the third week, continuing for three or 
four weeks after convalescence was established. Eventually the 
mental condition became normal. Dr. J. B. Cassady, of Burlington, 
reports about fifty cases of scarlatina in and about that city during 
the present spring, but says no other diseases have been epidemic. 

At Moorestown the usual diseases prevalent at each season have 
developed with their accustomed regularity, but no epidemic of any 
sort has occurred. Your reporter is of the opinion that follicular 
tonsillitis occurs much more frequently than it did ten years ago. 

The interest in our county society has been well sustained, the 
meetings well attended, and our membership is increasing. Among 
the papers read during the year may be noted one by Dr. Shipps on 
the •* Etiology of Typhoid Fever/* which was one of a symposium on 
that subject at the April meeting of the society. 

An^interesting record of a case of umbilical cord hernia was presented 
by Dr. Cassady. Operation was refused, and the child died in twelve 
days of septic phlebitis. 

During the year we have lost by death Dr. William L. Martin, of 
Rancocas, one of our oldest and most respected members. A short 
obituary prepared, at the request of the society, by Dr. N. Newiin 
Stokes, of Moorestown, is enclosed. 

Respectfully submitted, 

Joseph Stokes, Reporter. 



REPORTS OF District societies. 403 

CAMDEN COUNTY. 

To the Chairman of the Standing Committee^ etc, : 

At a meeting of the Camden District Medical Society held October 
14th, 1902, Dr. Emma M. Richardson read a paper entitled "Several 
Interesting Obstetrical Cases," for which she received the thanks of 
the society. 

Dr. William A. Davis reported a case of triplets and received tht 
thanks of the society. 

Dr. Daniel Strock read a paper entitled '* The Effect of the Scarcity 
of Anthracite Coal and the Use of Substitutes Therefor Upon the 
Public Health." The paper was of such interest that the society 
requested it to be printed in the Camden daily papers. The follow- 
ing is an abstract therefrom : 

•' Failing to get this variety of coal, efforts will be made to supply its 
place by the use of other heat-producing substances, and, in this sec- 
tion of the country, practically but three are available, namely, gas. 
bituminous coal and oil. The probable exigencies of the winter will 
render it imperative that one or the other of these methods of room 
warming shall be used to a greater or less extent. 

" Where gas is used, it is essential in order to obtain the greatest 
heat effect, that it be burned with a proper admixture of air, thus 
producing a blue flame, which is the heat flame, as distinguished from 
the yellow flame, that gives light. Also, the blue flame practically 
consumes all the gas that escapes at the burner, and thus minimizes 
the contamination of the atmosphere. 

" It may be stated as a fact, that a gas stove burning with a yellow 
flame is unsafe, from a sanitary point of view, because a certain per 
cent, of unconsumed gas escapes into the room, thus vitiating the 
atmosphere thereof; and no one can continue to breathe gas- 
contaminated air with impunity. 

" Where gas is used to heat a house or room, in addition to the 
observance of the above rules just n»entioned, it is essential that 
ventilation be secured by the lowering of the top sash of a window on 
the side opposite to the way the wind is blowing. 

" Much interest attaches to the use of bituminous, or the so-called 
soft coal, because we instinctively turn to coal in some of its varieties 
to supply the place of that which we have known from our childhood. 
Since the gravity of the coal strike situation has become understood 



404 MEDICAL SOCIETY OF NEW JERSEY. 

by the people, much has been said pro and con upon the subject of 
using bituminous coal in the household, and its use cannot be criti- 
cised upon the ground that it is a menace to health. If this variety 
of coal can be procured at a reasonable cost, then, in my judgment, 
there is no reason why it should not be used in our houses in prefer- 
ence to either gas or oil as a heat producer ; because, with proper 
care, it can be made to do all that anthracite coal will do ; but. it 
must be confessed, its use demands greater vigilance and skill than 
does the hard coal. 

" As before said, as medical advisers, we will be questioned upon 
this subject of house warming, and it is incumbent upon us to be 
prepared to give the necessary information upon a matter so vital ta 
the community. Therefore, it will not be out of place if we briefly 
consider the proper method of using bituminous coal in the ordinarily 
constructed heaters and ranges. 

*' I do not pose as an expert .upon the subject, but as I have been 
using it in my house for several weeks, I can speak from the practical as 
well as from the theoretical standpoint. The fire is started in the ordi- 
nary way, with light kindling wood, followed by heavier wood, which 
is to form the real basis for the fire. As the coal makes a dense smoke 
and gives off large volumes of gas when first placed upon the fire, it is 
necessary to have all the draft apertures at the bottom of the range 
or heater scarcely closed, and the direct draft from the surface of the 
coal to the chimney should be open. This permits the escape of 
smoke and gas to the chimney rather than through the apertures of 
the stove or heater into the room or hot air pipes, and thence 
throughout the building. 

" As the admission of air over the surface of the coal aids the com- 
bustion of the gases, and also the smoke, it is necessary that the 
aperture ordinarily found in the heater door and at the top and front 
of the range should be opened. As soon as the draft is well estab- 
lished in the chimney, the aperture at the bottom of the range or 
heater should be opened, to admit air to the coal from below. The 
first effect of heat, in addition to causing gases and smoke to arise^ 
is to fuse the soft coal into a solid mass. This is the process of 
coking. In this state the coal will burn for many hours, and will 
require no special attention ; but a hot fire will not be obtained. 

" To have and maintain a hot fire, it is necessary to break up the 
mass of coke and open the lower draft, thus permitting the air to 



REPORTS OF DISTRICT SOCIETIES. 40$ 

pass freely through the furnace or range. To maintain the fire 
through the night, it is well to have a hot bed of coals upon which to 
lay the fresh coal, and, after the cooking process has well advanced, 
make an aperture in one side of the mass to permit the escape of the 
gases from below, as otherwise they may pass through the crevices 
of the furnace into the hot-air flues, and thus vitiate the atmosphere 
of the dwelling, 

"In case the fire goes out at any time, all that is necessary' is to 
break up the coke, and with wood build another fire on top of the 
coke. Soon the entire mass will be burning. 

•'These principles of bituminous coal burning will apply to the 
various other coal-burning stoves found in many dwellings. 

'* Oil stoves for heating purposes are an abomination, and should 
receive the unqualified condemnation of physicians. But notwith- 
standing this assertion, and notwithstanding all that physicians may 
say on the subject, we can be assured that many of our patients, in 
the present emergency, will have resource to this makeshift to warm 
the usual living rooms of their homes, as well as the bedrooms, in 
some instances. There can be no combustion or burning without the 
evolution of gases, chiefly carbonic acid and carbonic oxide gases, 
and they are both fatal to animal life, if inhaled in large amounts. 

*' In ordinary burning of coal or wood these gases are passed off 
into the atmosphere through the chimneys, and therefore are innocuous, 
because they mix with the immeasurably larger volume of the oxygen 
of the atmosphere. But their deadly qualities are occasionally made 
manifest in dwellings, where, through carelessness or ignorance, the 
smoke-pipe or chimney has become stopped, thus preventing the 
free escape of the gases up the chimney. In such conditions of the 
flue the gases pour into the living rooms, and have many times caused 
the death of the occupants. Of more than one tragedy of this kind 
I have personal knowledge. 

" What occurs when coal or wood is burned, occurs also when oil 
is burned in lamps or stoves, with the difference only, that the products 
of combustion, in the case of oil burning, are permitted to pass off 
into the atmosphere of the room, instead of into the outer air; and 
the result is, the occupants of such rooms are continually inhaling an 
atmosphere vitiated by gases that, when taken into the lungs in large 
amounts, may produce death in a few moments. 

*' It must not be understood by this assertion that the idea to be 



406 MEDICAL SOCIETY OF NEW JERbEY. 

conveyed is that an individual occupying a room heated by an oil stove 
is in the imminent peril of the individual whose room is receiving 
from a stove the gases that should escape up the chimney. The one 
is in immediate danger of death ; the other is in danger of imparing 
his health, or rendering his system more susceptible to disease that 
may eventually cause death. 

** But in this connection, it may be said, that the individuals who 
would retire to a small bedroom and tightly close the doors and 
windows, as is so frequently done on very cold nights, and lights an 
oil stove with the intent of permitting it to bum all night, would be 
in great immediate danger. This is not an imaginary situation, as 
very recently I was consulted by a patient who asked my advice as to 
the feasibility of warming the bedroom with an oil stove, she 
intimating that the result would be more surely successful if the 
doors and windows were closed. 

*' That this method of heating will be largely resorted to in case a 
scarcity of coal continues, is evident from the fact that in recent years 
it has become the favorite method of warming certain rooms of the 
house, where the toil of caring for a stove was objectionable ; and 
on the other hand, by many who for economical reasons, felt compelled 
to depend upon it. Therefore, while some may listen to our cautions, 
many more will make a virtue of necessity and continue thus to warm 
their rooms. 

*' To this class we can only say that provision for proper ventilation 
be made by partly opening a window sash. The wick of the stove 
should not be turned very low, or so high that the flame shoots up to 
a great height in the stove. In both these conditions, imperfect 
combustion takes place, and more gas escapes into the room than will 
occur when the flame is of moderate size. The impression that 
prevails, that because the room heated by this method is saturated 
with moisture, therefore every precaution for safety has been observed, 
and the gases destroyed, is a mistake. To remain in such a room for 
a period is enervating. The occupants will generally be found to 
complain of malaise and headache, and certainly will be more 
susceptible to exposure to the cold outer air." 

Dr. W. M. L. Coplin, of Philadelphia, delivered an instructive 
address, entitled " The Doctor and Medico-legal Inquiries in Murder 
Cases." He was given a vote of thanks by the society. 

At the meeting held December 4th, 1902, Dr. Alfred Cramer read 



REPORTS OF DISTRICT SOCIETIES. 407 

an interesting paper on " The Etiology," Dr. Wm. I. Kelchner on 
•• The Diagnosis, Early and Differential," and Dr. W. W. Kain on the 
" Treatment (More Recent Methods) of Tuberculosis," all of which 
were listened to with deep interest. Dr. Elwood R. Kirby, of Phila- 
delphia, read a paper on the *' Surgical Treatment of Bright's Dis- 
ease," for which he received, the thanks of the Society." Dr. Andrew 
J. Downes gave us a talk on " Electro-thermic Hemostasis in Abdom- 
inal and Pelvic Surgery," and received the thanks of the Society. Dr. 
Joseph L. Nicholson reported a case of double extra uterine tubal 
pregnancy. He also reported for Dr. Paul Mecray (who was unavoid- 
ably absent) a case of large ovarian cyst, containing seven quarts of 
fluid. 

At a meeeing held February 3d, 1903, Dr. F. M. Wood read a 
paper on "The Causes that Lead to Prostitution," Dr. H. H. Sherk. 
one on the " Extent of Prostitution," and the Hon. E. G. C. Bleakley, 
on ** The Law and its Relation to Prostitution." *' Christianity 
and Its Relation to Prostitution," by Rey. J. Madison Hare (owing to 
the illness of the minister), had to be omitted. *' The Results of 
Prostitution as Manifested in the Domain of Medicine " was ably 
presented by George M. Gould. M. D., of Philadelphia. 

In answer to the query, *' What diseases have been prevalent in our 
county ? " Dr. Leavitt, speaking for Camden City, says : *' I wish to 
report that since May ist, 1902, to date, just one year, we have had 
reported at the Board of Health office 81 cases of smallpox in this 
city, and most of these were treated at the Municipal Hospital by 
myself with only two deaths (one baby and one man). Most of the 
cases during the warm months were mild. 

Scarlet fever has been the most prevalent disease during the year, 
but the cases were nearly all of a mild type. 221 cases were reported, 
and very few deaths were reported from these. 

Diphtheria has not been so prevalent during this year as last, and 
like scarlet fever, the cases were mostly mild and very few deaths 
occurred. 103 cases were reported. 

We had reported 14 cases of membranous croup. Nearly all of 
these proved fatal. 

Typhoid fever seems to have almost lost its job in Camden as only 
42 cases were reported during this time. The origin of many of these 
can be traced to some other place. 

Of tuberculosis I can not write with any degree of accuracy, as only 
a few cases get reported. 



408 MEDICAL SOCIETY OF NEW JERSEY. 

During last winter pneumonia was quite prevalent, and of rather 
a severe character. 

La-grippe has also been quite prevalent during the winter ; most 
of the cases being affected with more or less congestion or catarrhal 
trouble of the lungs and inflammation of the throat, pains in bade, 
head, etc. 

We have also had a large number of cases of rheumatism, which 
may be from the effects of la-grippe and wet weather during the 
winter. 

Dr. H. H. Sherk, reporting for East Camden, says : 

'* The diseases most prevalent in my section during the past year 
have been inflammatory rheumatism of a most severe type, grippe with 
a tendency to the abdominal variety, accompanied with vertigo and 
nausea, whooping-cough, chicken-pox and pneumonia, the latter not 
having been so fatal as during former years. There has been a 
marked absence of diphtheria, but plenty of tonsillitis, and some 
scarlet fever of a mild form." 

Dr. J. W. Marcy, referring to Merchantville, says : 

•' Measles, mumps and grip have been with us to the exclusion of 
almost all else during the past winter. All were mild, except that the 
grip was accompanied by a very severe spasmodic laryngitis." 

Dr. John R. Stevenson, reporting from Haddonfield, says: 

" The past year has been a comparatively healthy one in this 
section of the county. The summer was moderately free of the bowel 
diseases of both adults and children. Malarial fevers, although they 
occur sporadically in some localities, are yearly becoming more 
infrequent. There was no smallpox in Haddonfield, or in close 
Vicinity during the year. The nearest point in which it prevailed was 
a colored settlement, Snow Hill, about 1% miles from here. A few 
isolated cases of diphtheria and typhoid fever have been reported to the 
Board of Health. The cause of the later disease is usually credited 
to the bad water of Philadelphia where so many of our citizens spend 
the day, but one case under my care was surely caused by a waste 
water-closet well overflowing into the cellar. 

** The peculiarity of the slight epidemics of smallpox in this part 
of the county is the difficulty of diagnoses and the general mildness 
of the attacks. Differences of opinion have been held by painstaking 
doctors. Although I have had much experience in the disease, 
especially in the severe epidemic of 1872, I have never before seen 



REPORTS OF DISTRICT SOCIETIES. 409 

anything like it. In the last case, in an adult that came under my 
notice, no one could say from the eruption of five vesicles, whether it 
was varioloid or varicella. It was the prodromes that decided its 
character, viz : the non-impression of vaccination for ten years ; recent 
exposure to the contagion, sliglft suffusion of the eyes, and the 
preceding back and headache. This case was typical of many others." 

Dr. D. W. Blake, speaking for Gloucester, says : 

" The sanitary condition as well as the general health of the 
inhabitants of this city during the past year has been fairly good. 
But comparatively few cases of la-grippe appeared during January 
and February, and these were mild in type. Sporadic cases of scarlet 
fever and measles have appeared only to be stamped out by strict 
quarantine regulations. During the past winter we have had a 
number of cases of typhoid fever, mostly of a mild type, occurring 
among the employes of the New York Ship Building Co. So far, we 
have been unable to trace the source of the contagion. 

" All the streets are paved, and a most excellent sewer system is 
provided for the entire city. Mosquitoes are the pest of our lives, and 
yet malaria is almost unknown." 

Dr. A. L. Le Fevre, reporting for Blackwood Town, says : 

** Contagious diseases have been few in my practice this winter. 
I have had a few sporadic cases of scarlet fever and only one typhoid. 
La-grippe has been prevalent, complicated with pneumonia, and 
especially pleurisy. There has been a slight increase in obstetrical 
cases compared with last year's report." 

Two deaths occurred among our members during the year ; that 
of Alexander M. Mecray, which was reported in the Transactions 
for 1902, and that of James M. Ridge which happened on the 30th of 
January, 1903. 

At the last annual meeting, held in May, 1902, the active member- 
ship of our society consisting of 63 active members. During the year 
there have been 23 applications for membership. Fourteen of these 
have been voted on and elected, bringing the active membership up to 
76. while the honorary membership numbers 5. Our society is now 
larger than at any time in its history. This year we are honored in 
that one of our members. Dr. £. L. B. Godfrey, is President of the 
State Society. The same gentlemen is Secretary of the Board of 
Examiners for this State, which fact reflects creditably on the 
kind of talent we are developing, while at the same time the social 
eature of our meetings is encouraged and always much enjoyed. 



4IO MEDICAL SOCIETY OF NEW JERSEY. 

EXTRACTS FROM PRESIDENT'S ADDRESS. 

JOHN G. DORAN, A.B., M.D. 

Fellow- Members of the Camden District Medical Society : 

In an essay on Goethe's " Faust," by one of America's eminent 
scholars, we may find the following language : " But alas ! the tree 
of knowledge, always one of good or evil, according to the spirit of 
the one that gathers its fruits, has yielded him only vexation and dis- 
appointment." 

These words are spoken to us of Faust as he is presented to us in 
the opening scene of the great poem. He has " drunk deep at the 
Perian spring." but finds himself still parched with intellectual thirst. 
Like Icarus he has flown toward the sun only to find his wings fail 
him at the time of greatest need. The past reproaches him with its lost 
opportunities, the present reveals to him his weakness, and the future 
furnishes no hope of success. 

From this aspect of Faust we may educe a most important truth, 
namely, the fruits of knowledge are good or evil according to the 
spirit with which they are gathered. 

To-day let us gather of the fruit of the tree of knowledge and study 
its relation to man. 

Man in his entirety is divided into three parts— body, mind and soul. 

To the church, with its magnificent temples, eloquent clergy and 
almost unlimited wealth, is ascribed the care and development of the 
soul. 

The State, with its schools, its colleges, its universities, has taken 
control of the training of the mind. 

While to us, as physicians, has been given the body. What are we 
doing ? What can we do ? 

Let us gather of the tree of knowledge three fruits : 

First — Dirt breeds disease. 

Second — Pure air is essential to development. 

Third— Weakness is hereditary. 

In speaking of the first fruit, President Doran said that all the dan- 
gers to the public health arose from dirt. That dirt, when not 
actually the originating cause, was the hot-bed, the forcing house of 
disease. 

In presenting the second fruit, the speaker said what a man be- 
comes depends upon the air which he breathes. Some air is debilitat- 



REPORTS OF DISTRICT SOCIETIES. 4II 

ing. Some air is invigorating, full of ozone, stimulating, reviving. 
To breathe it is to get a new lease of life. It sends richness into the 
blood, elasticity into muscles, electricity into the nerves. 

It was the outdoor,' open-air life that made Babylonians, Per- 
sians, Greeks and Romans rulers at different times of the world, and 
it was the neglect of it which caused each of these empires to fall. 

It was outdoor, open-air life that gave the Greeks the Germans 
and the English the power to impress upon the world the greatest 
mental impressions. And it was no doubt essential to Christ's suc- 
cess in his three years of ministry that" the previous thirty years v^ere 
spent in an active, outdoor carpenter's life. 

Upon the third fruit President Doran, after speaking of several 
inherited weaknesses, said of insanity that in its diverse phases it is 
without doubt the saddest, the gravest, the most degrading and far- 
reaching in its consequences. 

From the tree of knowledge we have gathered and examined several 
fruits. What shall we do with them ? Shall we as physicians, know- 
ing that dirt breeds disease ; that foul air is debilitating ; that weak- 
ness in hereditary, remain inactive.^ Shall we, like Faust, use th^m 
for our own selfish ends ? Shall we continue the ancient and tradi- 
tional system of waiting until diseases are well developed, and then 
fight them as best we may ? Shall it be our duty to pull out with 
spasmodic effort the mangled wretches who float down to the sea of 
death in the torrent of disease and misery ? Or shall we strive to 
build firmly and maintain steadily the dykes which protect from the 
sources of disease and death ? 

We, as physicians, are given the God-like power of choice, but with 
it a fixed law of consequences. Whenever we gather selfishly of the 
tree of knowledge ; whenever, through prejudice, we investigate and 
teach a truth in part and refuse to consider it as a whole ; whenever, 
inflamed by passion, we pervert and falsify fact and law ; whenever, 
in fine, we seize the fruit of the tree with the aphorism in our mouth 
or heart, " Knowledge is power no matter whether for good or evil " — 
disappointment and sorrow are the unfailing results, both to ourselves 
and to society. 

The ultimate goal of human existence is human betterment, not to 
the individual, but to the race. To secure this betterment man must 
know the laws and relations which produce and control it and to 
them conform his actions. 



412 MEDICAL SOCIETY OF NEW JERSEY. 

That evils will accompany this increase of knowledge I do not and 
have not denied. But limit knowledge to escape the evils which it 
brings ! As well put out the sun's light that we may not see its spots. 
As well oppose the begetting of children because some monsters arc 
born. As well annihilate the wind because some ships are lost, or 
the rain because some streams overflow and devastate. 

If from some island-dotted bay the flowing tides were sud- 
denly drained away we should discover that all the islands which now 
lift their several summits above the surface are united below. Divided 
and separated above, below they possess an indivisible unity. 

The fruits which we have this day gathered from the tree of knowl- 
edge singly and alone become united when rightly applied to man. 

Let man keep himself free from dirt then disease will not sap and 
destroy the health given him by his ancestors. Let him live in the 
sun-lighted air. and to his ancestral-given health will be added greater 
health ; and, thirdly, the offspring of his union with a healthy mate 
will be stronger and healthier than what he was at birth. Thus 
the individual will become healthier, the progress of the nation will 
be greater, and the human race will more quickly approach that des- 
tiny to which it is slowly but ever trending. 

In this way use these fruits, and soon we will place man's body on 
the same high plane as that occupied by his mind, by his soul, and 
as physicians we will be lifted out of that deep abyss into which we 
have allowed ourselves to sink and take our proper place alongside 
the teacher of the mind, the minister of the soul, as the developer of 
the body, the physician. 

CAPE MAY COUNTY. 

To the Chairman of the Standing Cofnmittee : 

The regular meetings of the Cape May County Medical Society 

have been held throughout the past year, nothing of especial interest 

occurring, no papers read, nor cases reported before the society^ 

There have been so far as I know, no marked epidemics, with the 

possible exception of tonsillitis in the early spring months. Death has 

visited us but twice in the past year, removing from our midst Dr. 

Walter L. Learning, of Cape May City, and Dr. I. M. Downs of Cape 

May Court House. The obituary of each you will receive at another 

time, a committee having been appointed for that purpose. 

D. King Webster, Reporter. 
So. Seaville. N. J. 



REPORTS OF DISTRICT SOCIETIES. 413 

CUMBERLAND COUNTY. 

To the Chairman of the Standing Committee^ etc : 

At the July meeting, Dr. T. G. Davis gave an interesting report of 
the transactions of the State Medical Society, which was held in 
Atlantic City. 

Dr. S. M. Wilson reported progress in " therapeutics," giving many 
valuable points along that line. 

Dr. H. C. Miller reported a case of a boy nine years old with a 
peculiar skin affection, with rather a remarkable history, resembling 
more than any other disease, pemphigus contagiosus. 

At the October meeting, Dr. H. W. Elmer reported progress in 
" The Practice of Medicine." noting a number of advances during the 
past year, emphasis being placed upon the modern management and 
treatment of pneumonia and tuberculosis. 

Dr. G. £. Day regarded alkaloidal medication as a method of 
certainty, having practiced that method in part, as long as he had 
practiced medicine. 

Dr. G. E. Day reported a man 80 years of age with an immense and 
extensive carbuncle, also the good effects of bovonine as a remedy, 
the patient dying finally from cystitis. 

The following resolution was passed : 

^* Resolved, That we, the Cumberland District Medical Society, 
express our willingness to co-operate with Gloucester and Salem 
County societies in the formation of a Tri-County Medical Society." 
Amended, " To empower the president to appoint a committee of 
three if deemed advisable, prior to the next meeting, to confer with 
the other societies." 

The following committee was appointed :— Drs. H. W. Elmer, of 
Bridgeton, C. W. Wilson, of Vineland, and W. L. Newell, of Millville. 

At the January meeting, Dr. Joseph T. D. Howard reported a death 
from strychnia, granules having been left within reach of a child who 
ate several of them. 

At the April meeting. Dr. H. G. Miller reported progress in 
" Diseases of Children." 

Dr. Geo. E. Reading, of Woodbury, addressed the Society on the 
subject of the Tri-County Medical Society. 

Dr. W. F. Sprenkel, of ^Philadelphia, addressed the society on 



414 MEDICAL SOCIETY OF NEW JERSEY. 

" Prolongation of Pregnancy, its Dangers and Treatment," and Dr. 
Wilmer Krusen, of Philadelphia, gave an address on "Gynecology 
in General Practice." 

There has been one death. Dr. Joseph Sheppard, who for a number 
of years was treasurer of the society. 

Four applicants were elected to active membership during the year, 

Drs. F. P. Wainwright, C. B. Neal, Ernest Hummell, and Ferdinand 

Jones. 

H. P. Glendon, Reporter, 



ESSEX COUNTY. 

To the Chairman of the Standing Committee : 

It is my duty, as well as pleasure, to again present my report for 
Essex County. The annual meeting was held at its regular time with 
a large and enthusiastic attendance, more so than in several years past. 

A large increase was made in its membership, there being twenty 
new members added to our list. 

The president. Dr. J. T. Wrightson, read his' report, the title of 
which was ** Treatment of Disease and its Prevention as Evidenced by 
the Attitude of the People of Essex County." 

In this paper a splendid resume was presented of the work of the 
Medical Institution of the county, and it did credit to its author, by 
his very able and scholarly essay. 

A move was made at this meeting for extra meetings to be held 
during the year, for the discussion of the medical experiences of the 
members, in fact, we have begun to realize that a vast amount 
of material and experience has been lost by our neglect, and it would 
be to the advantage of our art, as well as to us personally, to meet 
more often than heretofore. It is hoped that this plan will be carried 
out in the near future. 

There was also offered a plan in conjunction with the Public Library, 
for the commencement of a medical library— certainly a very de- 
sirable thing for the largest city in the State — but how far our 
expectations are to be realized time will only tell. 

It is with regrets that I have to report that death has repeatedly 
visited our society, removing from our number the gray-haired and 
the youth. 

Dr. Arthur Ward, Frederick William Thum, Henry Melville Smith, 
and Robert Morris Sutphen. Appropriate obituary notices arc 
presented. 



REPORTS OF DISTRICT SOCIETIES. 415 

The Newark City Hospital has added to its staff Dr. Charles E. 
Teeter, as pathologist, and it is hoped that the vast amount of material, 
heretofore lost, will be ulitized for the advancement of the reputation 
of this worthy institution. 

Our private medical clubs are active, and in their several ways, 
keeping the flame burning, but I think it were better that we should 
combine in an unbroken, united profession, with but one interest, the 
advance of medicine and the improvement in its personnel. 

Our friends in Orange of the William Pierson Medical Library 
Association, have had a prosperous year, and have generously invited 
the profession generally to the feast of good things which they have 
provided. 

The following well known physicians were the essayists during the 
year : 

Prof. M. Allen Starr — " Arterio Sclerosis and its Effects upon the 
Nervous System." 

Prof. N. Stilman Thompson — " Auto-Intoxication." 

Prof. John B. Roberts — "The Pathology and Treatment of Surgical 
Septicaemia." 

Prof. Walter B. James— *• Modern Aspects of Malarial Infection." 

Dr. J. Edward Stubbert— "An Historical Sketch of some so-called 
Consumptive Cures." 

We wish them success and commend them for their good work. 

Dr. Richard Cole Newton has kindly sent me reprints of his papers 
published in the Medical Record, the titles of which are, •' Why is 
Modern School Life so Often Disastrous to the Scholars, Especially 
Girls," and " The Doctor and the School Teacher, Can They Not Work 
More in Harmony." Both subjects are timely and of great interest, 
and are handled as by a master. 

The same author discussed the subject, "The Hospital's Need of a 
Dental Staff," in a reprint from the International Dental Journal, and 
greatly strengthened the subject by his very able suggestions. 

I only mention to condemn the newspaper reports of the Tubercular 
Serum treatment in our City Hospital. While willing to admit the 
possibility of its doing good, consider it unethical and premature to 
offer the immature results of a few experiments as facts, and consider 
that the meagre results shown, do not merit the theatrical display to 
which we have been treated. 

We are at last, after two years of smallpox, free from this unnecessary 



4l6 MEDICAL SOCIETY OF NEW JERSEY. 

curse, the disgrace to our day and time, and we sincerely hope that 
we will never again have to contend with it in our midst. 

In closing, I must again call attention to the fact that I have 
received, with but the one exception noted, no reports of interesting 
cases or items of interest from the members of this Society, so will 
have to offer the few gleanings from the corners of a vast harvest 
field here presented. 

William S. Disbrow. Reporter, 



GLOUCESTER COUNTY. 

To the Chairman of the Standing Committee : 

The Gloucester County Medical Society has held five meetings dur- 
ing the past year, with an average attendance of twenty-two members, 
who. with the visiting members and delegates from adjoining counties, 
make the attendance about thirty-five. 

Following the custom of the past few years, the September meeting 
was given over to the annual banquet, which was held at Evergreen 
Hall, Woodbury, and, as usual, was a great success. 

I am pleased to report the flourishing condition of our society as 
manifested by the interest taken in matters of national importance as 
well as those confined within the limits of our own county. 

At our May meeting Dr. Halsey addressed the society upon the 
importance of all members looking after the medical legislation pro- 
posed each year. Only by concerted effort can pernicious legislation 
be prevented and proper laws be enacted. 

The attention of our Board of Censors has, on two occasions, been 
called to note the fact that parties were practicing medicine illegally, 
and the Secretary was instructed to correspond with the Secretary of 
the State Board of Medical Examiners, with a view to putting a stop 
to such practice. 

No epidemics of any note have been reported during the past year. 
A few cases of smallpox have occurred, but the disease has been con- 
fined to sparsely settled neighborhoods, and were put under strict 
quarantine. The last two or three cases were at once sent to the 
new isolation hospital, which has recently been built in connection 
with the Gloucester County Almshouse. 



REPORTS OF DISTRICT SOCIETIES. 417 

At each of our quarterly meetings, papers of much interest are read, 
both by members of the society and prominent teachers from the 
medical centers. 

There have been two resignations during the past year, those of 
Drs. H. C. Clark and C. M. Bert, both of whom were elected honorary 
members. 

There have been no new members to join our ranks, neither have 
we lost any by death, so our number remains the same as last year. 

W. Grant Simmons, Reporter, 

SWEDESBORO, N. J. 



HU-NTERDON COUNTY. 

To the Chairinan of the Standing Committee, etc: 

An exact idea of the comparative interest and strength of the 
Hunterdon County Medical Society may be gained from a statement 
made by our Secretary, Dr. O. H. Sproul, to the effect that there are 
now enrolled upon our membership list more active members than 
there ever have been since the organization of the society. This con- 
dition has been voiced at our recent meetings by an attendance which 
speaks in no uncertain way. It is particularly gratifying to see the 
young men who are rapidly invading this county not only applying 
immediately for admission, but also being willing and glad to assume 
such responsibilities as the society may deem proper to bestow. We 
feel justified, therefore, in hoping that there has come in the cycle of 
this society's life a period of ascendency, and in flaunting our success, 
banners without apology. 

Directing our attention now to the consideration of this county f ronv 
a medical standpoint, we are, indeed, pleased to record that there has 
been no epidemic of any importance during the past year. Measles 
and mumps have, in some parts of the county, had a fair number of 
cases to their credits, and diphtheria, in and about Flemington, has 
been the cause of the closing of the schools in that town. I am 
informed that the cases were, for the most part, of a mild type. In 
this connection it may be of interest to note that there is an element 
of discord in the profession at large as to the value of the laboratory 
diagnosis of diphtheria : in fact, there are some physicians who class- 
ify their cases as either " clinical diphtheria " or " laboratory diph- 
theria," using the latter term ironically. Frequently we hear of 



41 8 MEDICAL SOCIETY OF NEW JERSEY. 

quarantine being instituted because the card has come back marked 
*' positive " in cases where the specimen has been sent because there 
happened to be some cases of dipththeria within a few miles of the 
sore throat under treatment. It would appear that in such cases 
there is an excellent opportunity for the exercise of common sense 
and such judgment as will protect the community and at the same 
time not interfere unnecessarily with the normal functions of society 
at large. The two diseases conspicuously small in number of cases 
during the past year are typhoid fever and pneumonia. Isolated cases 
of each of these diseases have occurred throughout the county, but 
there has been neither epidemic of the one nor many cases of the other. 
Smallpox has not appeared in this county during the past year. We 
may well credit this to the general vaccination which was practiced 
one year ago, and which was made possible by the praiseworthy 
efforts of our boards of health. There is a number of cases now 
in the hands of physicians for the treatment of conditions which are 
presumed to be the results of the inoculation with vaccine. With the 
exception of these few questionable cases there have been few uncom- 
fortable results from the widespread vaccination which was carried 
out. One class of cases particularly singled out by the anti- 
vaccinationists is that of lymph-adenitis. Certainly these cases are 
not rare at the present time ; in fact, they are seldom rarities. Per- 
sonally. I am of the opinion that these cases, of which I have seen a 
few during the past year, are entirely independent of vaccination, so 
far as their etiology is concerned. 

Returning to the condition of the society itself, there is a healthy 
spirit of discussion growing which has already been productive of 
good, it being a common thing for men to report interesting or diffi- 
cult cases and invite criticism or ask advice. Altogether the meeting^ 
are of a highly practical character, and, indeed, are a privilege and 
not a duty. 

It is fitting that mention be made of the excellent services rendered 
by the retiring Reporter, Dr. George N. Best. Through a number of 
years he has faithfully served the society in performing this important 
function in a very creditable manner, and it is a question if there will 
be found one who will fill the place half so well as he has done. 

it is a pleasure to report that there have been no deaths in the 
society during the past year. 

Leon T. Salmon. Reporter. 



REPORTS OF DISTRICT SOCIETIES. 419 

MERCER COUNTY. 

Jo the Chairman of the Standing Committee^ etc. : 

The Mercer County Society has another successful, entertaining 
and instructive year s report to make. The papers read and addresses 
and reports of cases presented have been characterized by thought- 
fulness and thoroughness in preparation, and the ensuing discussions 
have been of much value. During the year we have added ten new 
members and lost three — two by removal and one by death — a net 
gain of seven. 

At our annual dinner held November 11, 1902, Dr. Barton Cooke 
Hirst, of the University of Pennsylvania, was the guest of honor. 
He delivered a very exhaustive and instructive address on " The 
Necessity of a More Careful Examination and Treatment of the Patient 
During Puerperium," which was afterward discussed freely. 

At the June meeting Dr. C. F. Adams read a paper on •* The Need 
of a New Public Library in the City," in which the needs of such an 
institution were well set forth. 

Again, at the October meeting, the same gentleman read a paper 
on " Glaucoma." Quoting from Von Graefe, he said : " The essence 
of glaucoma lies in the increase in the intra-ocular pressure, from 
which all other essential symptoms of glaucoma can be deduced." 
In primary glaucoma the condition arises without any discovered 
antecedent cause, the primary important essential symptom being 
the increased tension. In the secondary form the increased tension 
is a sequence or accessory of some other pathological condition, and 
its clinical picture is as varied as the conditions from which it arises. 
It remains con6ned to the diseased eye, while the primary form affects 
both eyes. The consequences of the increased tension are excavation 
of the optic nerve and ultimate annihilation of sight. 

Dr. F. V. Cantwell reported a case of gall-stones, with specimen ; 
also a case of ectopic pregnancy, with specimen. 

Dr. Cornelius Shepherd reported a case of convulsions following 
confinement. 

Drs. G. H. Franklin and F. V. Cantwell, at the January meeting, 
reported an ** Unusual Case of Uterine Fibroid." 

Dr. Franklin presented the history of the case to time of operation, 
as follows : 
Mrs. S., aged 49; white; large, masculine woman, usually in good 



420 MEDICAL SOCIETY OF NEW JERSEY. 

health ; married ; one child ; miscarried at third month in October, 
1893. During 1899 and 1900 menstruation often absent two or three 
months; flow was never profuse. There was slight pelvic pain, ner- 
vousness and emaciation. Patient refused examination. In March, 
1 90 1, peculiar contour of the abdomen was noted, and a tumor about 
the size of a man's head easily mapped out. Vaginal examination 
showed entire body of uterus involved, but patient refused consulta- 
tion and operation. In May, 1901, foul vaginal discharge commenced, 
and Dr. Cantwell was called and confirmed diagnosis of uterine 
fibroid, and on May 20th operation performed by Dr. Cantwell, who 
removed a large fibroid uterus. During the convalescence the respir- 
ations ranged from 25 to 40. On the forty-ninth day after the opera- 
tion, from which patient had entirely recovered except for rapid 
breathing, the dyspnoea suddenly increased, patient unable to lie down, 
pulse 140 and very weak. The symptoms indicating pleural effusion, 
paracentesis was done, and eight ounces of bloody serum withdrawn. 
Respirations were now 50 to 60, pulse 160. These symptoms con- 
tinued with remissions until sixty-first day after primary operation, 
when death occurred during severe struggle for breath. The lungs at 
autopsy revealed presence of great numbers of small tumors, in size 
from that of a marble to a walnut, scarcely attached to the lung, and 
almost dropping out when exposed. The important feature of this 
case was the wide metastasis and profuse recurrence. This may 
have resulted from portions of the tumor entering the larger veins 
and being carried to the lungs. It is almost certain that metastasis 
had occurred before operation. The mode of death was peculiar in 
that it was due to mechanical destruction of lung tissue and not to 
malignant character of growth. Microscopical examination showed 
tumor to be a round-cell fibro-sarcoma. 

Dr. G. N. J. Sommer reported an interesting case of brain tumor, 
the symptoms of which were vomiting, pain in right anterior half of 
head, and slight internal squint with dilated pupil; finally partial 
loss of power in left side and total blindness. The diagnosis was 
tumor involving the right frontal lobe and pressing on hand and arm 
segments, of right motor area. The tumor was a dark red mass, 
firmer than brain tissue, with a necrotic centre from which flowed a 
gritty semi-fluid material. The cavity left after removal was about 
5 c. m. by 2 c. m., and bled freely, but hemorrhage was controlled by 
packing. The child died in convulsions on nineteenth day after 
operation. 



REPORTS OF DISTRICT SOCIETIES. 42 1 

Dr. Charles L. Allen, of the State Hospital, at the February meet- 
ing, presented specimens and histories of cases, with remarks on the 
same, of — 

1 . Rare tumor of the brain. 

2. Tumor of the spinal cord. 

3. Perforation of intestine. 

4. Cancer of colon and liver. ' 

5. Brain from general paretic. 

6. Specimen illustrating diagnosis of rabies. 

Also for diagnosis, a patient with mycosis of fingernails. 

This proved to be one of the most enjoyable and instructive meet- 
ings of the year. 

Dr. H. B. Costill, at the March meeting, read a paper on the 
" Immediate Repair of Perineal Lacerations." He said the lacera- 
tions might often be avoided by aiding expulsion of head between 
pains, and if lacerations did occur, they should be repaired within 
twelve hours if possible. 

Dr. A. J. Hunt read an exhaustive papier on '* Endometritis *' at the 
May meeting. 

In response to a letter from Dr. L. M. Halsey, chairman of the 
Committee on Legislation, the following answers were sent : 

No definite action has been taken by the society to suppress the 
illegal practice of medicine. 

That all persons practicing any or all branches of medicine should 
be required to pass the State Board of Medical Examiners and be 
registered the same as any regular practicing physician. 

Fee for examining indigent insane patients, $10.00. 

Fee for post-mortem ordered by coroner, $25.00. 

Fee for testifying at inquests, $10.00. 

The Trenton Medical Library is in a very flourishing condition, 200 
volumes having been added during the year, making a total of 700 
vo'lumes, which with the twelve journals regularly received, are 
frequently and profitably consulted by the members of the association. 
During the year the association has heard addresses from Dr. George 
Gould, of Philadelphia, on " Medical Discoveries by the Non-Medical," 
and since published in the May 30th number of the Journal of 
the American Medical Association ; ** Reminiscences of Dr. Charles 
Skelton, the Founder of the Trenton Free Public Library," by Dr. 
Cornelius Shepherd and Mr. John Briest ; by Dr. William Osier, of 



422 MEDICAL SOCIETY OF NEW JERSEY. 

Johns Hopkins University, on "The Uses of a Medical Library, 
and by Professor Abbot, of the University of Pennsylvania, on 
" Filtration." 

The officers of the Library Association are Dr. F. V. Cantwcll, 
President ; Dr. H. G. Norton, Vice-President ; Dr. J. Cooper, Treas- 
urer. 

While the health of the city has not been bad, the showing is not 

so good as for the preceding year, as the following will show : 

From May, From May i, 
Diseases Reported. 1901, to 1902. to 

June I, 1903. June i, 1903. 

Diphtheria 33 109 

Typhoid Fever 90 282 

Scarlet Fever 36 91 

Smallpox 35 13 

Tuberculosis 34 33 

During the year we have lost by death one of our most active and 
valued members, Dr. Wm. M. D. Struble, which occurred on August 
28, 1902. 

The hospitals have done more work this year than ever before. 
Mercer Hospital has been enlarged, and now has a capacity of 100 
beds. St. Francis Hospital is also having a $60,000.00 addition built, 
and when this is finished a training school for nurses will be estab- 
lished. 



MIDDLESEX COUNTY. 

To the Chairman of the Standing Committee : 

During the past year the Middlesex County Medical Society has 
held its regular' quarterly meetings, which were well attended and 
have aroused considerable interest in the work of the Society. While 
our numbers have been increased by the addition of new members, 
we have suffered a severe loss by the death of Dr. Nicholas Williamson 
on August 15th, 1902, of typhoid fever, after a three weeks illness. 

During the past winter, we in New Brunswick have had many 
more than the usual number of cases of diphtheria. There have been 
reported 254 cases of diphtheria, with nine deaths, a very creditable 
showing. 

We also had reported twenty-three cases of smallpox, all but two 



REPORTS OF DISTRICT SOCIETIES. 423 

of which were among the colored population. The almost complete 

confinement of the disease to such an unmanageable class of people^ 

speaks well for the efficient work done by our local board of health. 

We had reported, nine cases of typhoid fever, with one death, that 

of Dr. Williamson as above noted. 

H. L. Smith, Reporter, 



MORRIS COUNTY, 

To the Chairman of the Standing Committee : 

Papers upon the following subjects have been read before the 
Society during the last year. Each paper was good and the discussion 
following lively and interesting. 

" Common Injuries and Diseases of the Eye," by Dr. L. L. Mial. 

*• Haematuria," by Dr. H. A. Henriques. 

" Electricity in Gyneology." by Dr. N. H. Adsit. 

" Disturbances of the Circulation," by Dr. W. S. Foster. 

" The Anaesthetist," by Dr. J. W. Farrow. 

" General Paralysis of the Insane," by Dr. P. S. Mallon. 

A number of interesting cases have been reported at almost every 
meeting. 

No general epidemics have prevailed in the county during the past 
year. A few cases of smallpox have occurred and a few typhoids. 

No members have died during the past year. 

Our Society has made very gratifying advancement all along the 
line. Its membership has increased to 60. The number of meetings 
has increased from two to four. The interest in the papers read and 
cases reported, and the activity and pertinence of the discussions 
following, show that the society is doing a good work for its members. 
Respectfully submitted, 

Stephen Pierson, M.D., Reporter. . 



SALEM COUNTY. 

To the Chairman of the Standing Committee : 

The Salem County Medical Society has held three meetings during 
the past year. These meetings have been well attended and consi(!er- 
able interest manifested. 

Dr. Daniel Strock. of Camden, attended two of these meetings and 
gave us very interesting talks on surgical subjects. 



424 MEDICAL SOCIETY OF NEW JERSEY. 

At our last meeting, Dr. E. E. De Groft. of Woodsiown. read a 
paper on ** The Vicissitudes of a Doctor's Life." A copy of which I 
enclose. 

The Society has gained two new members during the past year, and 
I am happy to say has lost none through death. 

The health of the community has been comparatively good. During 

the months of February and March, la grippe appeared in a mild form. 

Parotitis has been quite prevalent and of a severe form among adults, 

but with the children it has been mild. Typhoid fever has been 

almost unknown, and there have been comparatively few cases of 

pneumonia. 

W. H. Carpenter. Reporter, 

THE VICISSITUDES OF A DOCTOR'S LIFE. 

BV E. E. DE GROFT, M.D., WOODSTOWN. 

Although I deem it an honor to be the essayist for this meeting, yet 
it was with a degree of reluctancy that I consented to accept the 
invitation, as I am a much better listener than a speaker. However, 
even though the effort may prove to be a humble one, I shall fulfill my 
promise to you ; angels could do no more. 

I have selected for my theme something that is out of the usual order. 
Instead of treating upon some medical subject. I have decided to 
speak in a general way upon the vicissitudes of doctors' lives. 

Is it possible to conceive of a more noble and humane calling than 
that of the medical profession ? 

Think for a moment of the overworked physician, more especially 
in a country practice in his visitations to the sick, ministering to their 
ills and ailments upon every hand, very often sacrificing his life by so 
doing, responding to midnight calls, matters not how inclement the 
weather, knowing very often when he is called that he will not receive 
any compensation whatever for services rendered other than perhaps 
words of praise only while alleviating the sufferings of the patient, and 
words of condemnation after recovery if a bill is rendered, which 
reminds me of the following verse that I once read which I think is a 
typical case of ingratitude. 

" God and the doctor we both adore 
When in sickness, but not before ; 
When the suffering is o'er they are both requited, 
God is forgotten and the doctor slighted." 



REPORTS OF DISTRICT SOCIETIES. 425 

That undoubtedly has occurred in the practice of every gentlemen, 
present. 

There are no men in any profession, that are more philanthropic,, 
more self-sacrificing, and more earnest in their untiring efforts to 
relieve suffering humanity, and to do good generally in the community 
in which they live, than physicians. 

Because of the great mission that we have started out upon after 
bidding farewell to our almamater, and the grand work that we are 
engaged in daily among our fellow-men, we are led to believe that the 
medical fraternity ranks second to none among the professions of the 
day, and yet we are more poorly remunerated than any other. The 
lawyer for instance receives a cash fee of $5.00 for an office consulta- 
tion, while the doctor's fee for knowledge that often is very 
much more important is usually fifty cents, and he is fortunate who 
always gets it in cash. 

But he who enters the profession solely and only for the emoluments 
received, does not in my mind constitute a true physician. Our mission 
is not only to aid nature in healing the sick and alleviating the suffer- 
ings of those who are in need of our assistance, for the monetary 
return that we expect, but our sympathy should go out to those who 
are in distress, and words of cheer and comfort should accompany 
the prescription also. 

Sick people as a rule are easily influenced, and doubtless it has been 
the experience of some of us, that if the patient's condition should 
suddenly become alarming, a change in physicians may be made» 
perhaps without even consulting us. Instead of becoming 
indignant and giving vent to our pent up feelings at such treatment, 
it is far better that we pleasantly submit to their whims and graciously 
bow to the inevitable, and by greeting the family as pleasantly after- 
ward as before, and letting the occurrence pass by unnoticed, the 
probabilities are that in the event of another member of the family 
being taken ill you will be recalled. Such at least has been my 
experience. 

Professional courtesy and kindly greeting to our fellow practitioners 
of whatever system, should be commended if they are honorably 
disposed, otherwise they should be discountenanced. 

As physicians, and as a society, let us uphold our profession and 
prove ourselves to be in the eyes of the public, all that we should be, 
and at all times discourage any pretension or tendency whatever to 



426 MEDICAL SOCIETY OF NEW JERSEY. 

chartalism, quackery or petty jealousy. Life is too short to take the 
advice of David Harum to " Do unto the other fellow as he would 
do unto you, but do it first/' which it is needless to say is not the 
golden rule. But let us grant to others, regardless of school or 
system, what we claim for ourselves, the right to legitimately practice 
our profession with the view that each one stands or falls upon his 
own merits. 

Honorable competition is permissable in all lines of business, but 
any demonstration of ill feeling toward our opponents is to be con- 
demned, even though such a course may appear to us to be perfectly 
justifiable, yet the laity will not take the same view of the case as we 
do, and invariably will conclude that our action was prompted by a 
jealous motive. A case in point. Many unkind and unprofessional 
remarks made by an older practioner about a younger physician 
just beginning life, resulted in the upbuilding and advertising of the one 
that was persecuted, and redounding to the discredit of the persecutor. 
And the younger man who was the target of the ungentlemanly 
epithets indulged in by the older one. held his own council, kept on 
in the even tenor of his way. and followed the advice of an old farmer,. 
'* that the still hog got the swill." and in a short time he became the 
happy possessor of a lucrative practice. I have found that the success- 
ful physician in a community is he who is a close obser\'er of human 
nature, a cautious and careful diagnostician, a diplomat to a certain 
extent, and who in a pleasant and cheerful manner will accommodate 
himself to circumstances as they confront him. 

No one can afford to practice medicine for glory alone, so a fair 
compensation for services rendered is also an important factor in a 
successful practice, and the standard of our profession should be 
maintained in that particular, and an established fee system inaugurated 
and adhered to at all hazards, in order to protect ourselves as a 
fraternal society. 

Speaking of protection, do we as members of the medical profession 
live up to and practice the friendship toward each other that we 
should ? And is there the professional etiquette manifested among 
medical men practicing in the same community that there should btr ? 
I am afraid gentlemen, that there is vast room for improvement, and 
what is needed as much as anything else in our noble calling, is more 
charity for each other. Let us then refrain from indulging in petty 
jealousies, rivalries, and personalities. If one physician should 



REPORTS OF DISTRICT SOCIETIES. 427 

perchance become more fortunate than his brother in his professional 
attainments and skill, he should be congratulated and encouraged to 
continue in his investigations that the profession generally might be 
benefited thereby. 

Neither is it tact or good policy to speak unkindly to our patients of 
those of the opposite school if they are pursuing a legitimate practice 
and have conformed to the requirements of the laws of our State, they 
have equal rights with others and should be accorded the same privi- 
leges. 

What a mixture a doctor's life is. It is certainly not always one of 
ecstatic joy. He is supposed to be at all hours at his post of duty, 
ready to respond to the beck and call of the public ; no regular time for 
rest or recreation, and in the event of an unavoidable death occurring 
in our practice, we are subjects of adverse criticism. Yet I fully believe 
that the rank and file in every community appreciates an honest, con- 
scientious and matter of fact doctor. So, regardless of the opinion 
of the world, I trust that we will be true to our fellowman, true to 
our God, and true to ourselves. 

William CuUen Bryant once said : 

Truth crushed to earth shall rise again — 

The eternal years of God are here— 
But Error wounded writhes with pain. 
And dies among his worshipers. 

There is no class of men whose actions and deportment are more 
carefully watched and commented upon by the public than physicians. 
Shall we not then be like Caesar's wife, not only virtuous,' but above 
suspicion ? 

I have never forgotten the timely admonition g^iven to the class 
when a student by the late Prof. Ellerslie Wallace, and that was, 
•' always insist upon having a third party present when making [a 
vaginal examination, by so doing," he stated, " you will always escape 
slander and blackmail " ; and so, throughout my. entire professional 
life I have followed his advice and have jealously guardedlmy'rcputa- 
tion in that particular as well. 

Young girls, and married women as well, have come to my office 
pleading with tears asking for some emmenagogue ; the young|women 
with a plea to prevent disgrace and save her character, and the mar- 
ried women with a pretext that they already have more children than 
they can support. 



428 MEDICAL SOCIETY OF NEW JERSEY. 

In every case, and I have had quite a number of them, I invariably 
point out to them not only the great danger of the proceedurc but 
also the criminality of it as well. 

If they still insist that I must render them assistance and refuse to 
listen to reason, I then at once meet their earnest entreaties in a lan- 
guage that is unmistakable, and promptly refuse to entertain any 
proposition whatever, firmly believing that it always pays to follow the 
dictates of your conscience and never is safe to do wrong. 

I knew of a brilliant physician whose prospects in life were unusually 
bright, but who, at the earnest solicitation of his patient, performed 
an operation that was both illegitimate and criminal, and in conse- 
quence spent years behind prison bars. 

In my opinion there is no better safeguard or shield to the medical 
profession, individually or collectively, than to become identified with 
a good medical society. Such an organization not only affords pro- 
tection, but gives prominence to its members as well. And apart 
from the intellectual feast that we are sometimes treated to at our 
society sessions, by the reading and discussion of various papers of 
interest, the social features of these gatherings are of great import- 
ance. 

The pleasant greetings and hearty handshakes extended by its 
members more than repays one for the sacrifice he makes in leaving 
home and practice to be present at our society meeting. 

Exaggerated statements made by physicians of wonderful cures 
effected and operations performed should be guarded against, espe- 
cially when such statements have no semblance of truth whatever, 
even though they are credited by the laity or uninformed. Evidently 
the motive for doing so is purely for personal advertisement, which, 
undoubtedly, was the case of a physician who is not, I am pleased to 
say, a member of this society, who at one time said that he performed 
an operation for Caesarian section unaided and alone on a patient, and 
the remarkable part of the story is, that it was so successful that 
mother and child both lived. Comment is unnecessary. 

To be able to discern the likes and dislikes of our patients, to be 
careful and thorough in our diagnosis of diseases, and to keep abreast 
of the times by reading something more than the daily newspapers, 
goes farther towards making up the component parts of a successful . 
physician than fluency of speech or the facility of expression. 

Common sense is also, I think, one of the essentials of a successful 



REPORTS OF DISTRICT SOCIETIES. 429 

professional life, and in a measure should supersede too much theory. 
A certain portion of theory, however, may be proper, but practical 
experience and foresight tinctured with mother wit judiciously applied 
in my opinion brings better results. 

In making professional calls experience has taught me that a certain 
amount of tact and judgment should be employed. While some 
would perhaps think it proper and in order to enter their homes 
uncerimoniously, others would deem it rude and a violation of 
etiquette to do other than to announce yourself by a ring of the door 
bell and out of order to be anything else than dignified. Hence the 
importance of discrimination, which applies equally as well to our 
visits to the poor as to the rich. 

In speaking of the poor, physicians render more unpaid services 
than any other class of people in the world. The poor, said a 
renowned physician once, are my best patients. God will be their pay- 
master. But even in doing charity we should discriminate. There 
seem to be two classes of the poor — the Lord's poor and the devil's 
poor. I have found that the less w^e have to do with the latter and 
the less strength and health we expend on them the better it will be 
as a rule for us. They are in many instances the lowest and meanest 
victims of vice, intemperance and sensual indulgence. It matters not 
what attention may be given such cases, they are usually ungrateful, 
and I cannot contemplate a greater sin than ingratitude for services 
rendered when no remuneration is received, especially when we must 
face contagion and inhale noxious gases or vapors, encounter the 
filthiest kind of filth, and perform many distasteful and disgusting 
duties. As servants of the public, we must endure August suns and 
the blasts of winter months. We are supposed to respond to the 
calls of Tom, Dick and Harry, whether it is at noon or the midnight 
hour. While others are resting or refreshed with sleep we must go. 

A physician is in continual danger, and when, like a wild tornado, 
the swift, gaunt, ghastly, withering epidemic begins its work of death, 
no matter how great the hazard, he must from a sense of duty take 
his life in his own hands, as a brother physician has recently done at 
Clayton, New Jersey, in an epidemic of diphtheria. This physician, 
by devotion to duty and nobly standing at his post, has contracted 
the disease in its worst form, and is, I think, at the present time under 
quarantine. 

Some one has divided man's life into four periods, and called the 



430 MEDICAL SOCIETY OF NEW JERSEY. 

first twenty years the period of preparation, from twenty to forty the 
period of struggle, from forty to sixty the period of victory, and after 
sixty rest. Not so with the physician ; his struggles lasts till life ends. 

Dr. Jarvis estimates the average length of life of a physician at 
fifty-six years. If you begin practice at the age of twenty-four, your 
active life prospect will be 32 years, and from a thousand to fifteen 
hundred dollars will represent your average yearly income. From 
the day of leaving college, through all the phases of our professional 
life down to old age, with not even a Sunday to rest or to call your 
own, you would have but little after all expenses are met to support 
you after you naturally reach the down hill of life or are broken in 
health and in need of a physician yourself, through worry, anxiety 
and fatigue in the discharge of duty, and by such faithfulness Heaven 
knows that we deserve better treatment and more comfortable sup- 
port than we ofttimes receive. 

The subject being a broad one, much more could be said if time 
would permit and you had the patience to listen, but I will desist, and 
in conclusion let me exhort you, as did the apostle his disciples: 
" Giving all diligence, add to your faith virtue, and to virtue knowledge, 
and to knowledge temperance, and to temperance patience, and to 
patience godliness, and to godliness brotherly kindness, and to 
brotherly kindness charity." 

SOMERSET COUNTY. 

To the Chairman of the Standing Committee : 

The meetings of the Somerset County District Medical Society have 
been unusually well attended. At the annual meeting held in April, 
the following officers of the society were elected : President. Dr. C. 
R. P. Fisher, of Bound Brook ; Vice-President, J. P. Hecht, of Somer- 
ville; Secretary, J. H. Buchanan, of North Plainfield ; Treasurer, 
T. H. Flynn, of Somerville ; Reporter, W. H. Long, of Somerville ; 
Delegates to the State Medical Society, Drs. J. H. Buchanan, North 
Plainfield ; T. H. Flynn, Somerville ; M. C. Smalley, Gladstone. 

After the routine business of the society had been transacted. Prof. 
H. Augustus Wilson, of Jefferson Medical College, Philadelphia, 
read a very interesting paper on " The Advantage to be Derived from 
the Early Diagnosis of Tubercular Joint Diseases." This was fol- 
lowed by a discussion in which all the members of the society took 
part. Short addresses were also made by Dr. John Ward, of the 
Trenton State Insane Hospital; Dr. A. Treganowan, of South 



REPORTS OF DISTRICT SOCIETIES. 43 1 

Amboy, and Dr. O. H. Sproul, of Flemington. Following these, the 
society and its guests partook of the annual dinner, which event was 
enjoyed by all. 

At the regular quarterly meeting, held in July, a paper on " Diph- 
theria" was read by Dr. J. H. Buchanan, of North Plainfield, and 
informal discussions of various medical and surgical topics by all took 
place. 

At a special meeting held on March 14th. a committee was 
appointed to go to Trenton and appear before a Senate committee to 
oppose Senate Bill No. 282, which proposed to license osteopaths to 
practice in New Jersey. The committee, consisting of Dr. A. L. 
Still well and Dr. W. H. Long, Jr., went to Trenton and appeared at the 
hearing. The opposition to the bill was so great that it was not 
reported by the committee to the Senate at all. 

The Somerset County Society has gained two new members during 
the past year— Dr. F. Hughes, of North Plainfield, and Dr. Funk- 
houser, of the State Epileptic Colony, at Skillman. There have been 
no deaths in the society during the past year. 

There has beon about the average amount of illness during the 
year. The small number of children suffering from gastro-intestinal 
disturbances seemed unusual in the summer. There were a few scat- 
tered cases of typhoid fever during the autumn months, also the 
average number of cases of diphtheria and scarlet fever. 

During the late fall and winter months we had the greatest number 
of smallpox cases in many years. In South Bound Brook there were 
twenty cases, several isolated ones on the mountains north of Somer- 
ville, three at Burnt-Mills, and one near Rocky Hill. These cases 
were all contracted from some one who came from New Brunswick, 
it is thought. Somerville prepared for an epidemic by building a small 
isolation hospital, which was not required. All children in the public 
schools were ordered to be vaccinated at the expense, if necessary, of 
the local board of health. Nearly all the unvaccinated were vaccin- 
ated, and no new cases occurred. 

Our local society is in a very flourishing condition. The meetings 
are all well attended and either a paper read or a discussion held. 
For the next year it has been arranged that each member, in alpha- 
betical order, shall read a paper. 

I am sorry to state that I have received nothing to report from our 

out-of-town members. 

W. H. Long, M.D.. Reporter, 



432 MEDICAL SOCIETY OF NEW JERSEY. 

SUSSEX COUNTY. 

To the Chairman of the Standing Committee : 

The members of the Sussex County District Medical Society are in 
general separated by considerable distance, and it has not been prac- 
ticable to hold but one meeting a year. 

With four exceptions, all regular physicians of the county are 
members of the society. 

The last annual meeting, held May 19th of the present year, was 
attended by eleven members, about one-half of the membership of 
the society. Notwithstanding the small attendance the session was 
an interesting one. Three papers were presented. The President's 
address on ** Appendicitis " was actively discussed. Dr. H. D. Van 
Gaasbeck's remarks on the subject were listened to the more atten- 
tively because of a recent severe case in a member of his own family. 

Dr. M. D. Hughes, of Layton, exhibited a pathological specimen of 
an aneurism of the ascending aorta taken from a recent case of his. 
The growth was of immense size, the walls having become greatly 
thickened in the efforts at repair. A neglected thin spot adjoining 
the pericardium was the site of a small rupture, which was the cause 
■ of a sudden fatal termination. The doctor gave an excellent demon- 
stration of the specimen and report of the case. 

The next meeting being the seventy-fifth anniversary of the society, 
there was some talk of fittingly commemorating the event. 

There has not been more than the usual amount of sickness in the 
county the past year. No epidemic disease has prevailed except 
measles, which at the present time is quite prevalent in the northern 
and western portions of the county. 

I regret it is my duty to have to report for the first time in many 
years the death of two members of our society — Drs. Carlos Allen 
. and Sidney B. Strahley, both of whom have been active and esteemed 
- members. I enclose brief obituaries. 

Shepard Voorhees, M.D., Reporter. 



UNION COUNTY. 

To the Chairman of the Standing Committee, etc.: 
* The one hundred and twenty-fifth regular meeting of the society 
was held at Elizabeth, and was well attended, interesting and 



REPORTS OF DISTRICT SOCIETIES. 433 

instructive. Dr. S. T. Quinn read a worthy paper on " Intestinal 
Obstruction." Dr. Hedges reported a case of absence of the appen* 
dix. At the two succeeding meetings there was no paper, the essayist, 
one of the older members of the society and a very busy practitioner, 
was absent. This was discouraging to the President and very disap- 
pointing to the members, and it almost seemed as though the life 
of the society was suffering from shock ; however, as it always is, 
the reports and discussion of cases were beneficial. Dr. £. B. Grier 
reported a case of absence of the uterus. At the final meeting of the 
year the Princeton "ninth-inning" activity was manifest. The 
President, Dr. T. F. Livengood, read an able paper on "Acute 
Rheumatism." Dr. J. P. Reilly exhibited an appendix in which 
was embedded an ordinary pin. 

The health of the county has been fairly good. A general idea 
can be obtained from the following reports of the boards of health of 
Elizabeth and Plainfield, which cover the period from July i, 1902, to 
June 22, 1903: 

ELIZABETH, N. J. 

Diseases. Cases. Deaths. 

Typhoid Fever 95 21 

Scarlet Fever 63 i 

Diphtheria 231 9 

Measles 13 o 

Smallpox 10 4 

Whooping-Cough 86 12 

Tetanus * 2 2 

Tuberculosis 69 69 

PLAINFIEI.D, N. J. 

Diseases. Cas«s. Deaths. 

Typhoid Fever 36 4 

Scarlet Fever 36 5 

Diphtheria 81 7 

Measles 8 o 

Chicken Pox 8 o 

Smallpox 4 I 

Pneumonia was quite prevalent during the viinter. Quinine injec- 
tions were favorably used in the treatment. A number of cases of 
the intestinal variety of ir.fluerza were reported. Elizabeth had an 

2S 



434 MEDICAL SOCIETY OF NEW JERSEY. 

epidemic of whooping-cough, and typhoid fever has been endemic. 
There has been an especially large fatality from railroad and trolley 
accidents. 

The fee system is in process of revision. Simply reading it almost 
makes one feel wealthy. 

There was some agitation regarding the prosecution of irregular 
practitioners, osteopaths, etc. The Prosecutor offered his services. 
Dr. E. L. B. Godfrey advised the society that it should be very sure 
of its evidence before bringing suit. Nothing developed. 

The Elizabeth General Hospital has been equipped with an X-ray 
apparatus by the clinical society of the hospital, as a memorial to the 
late Hon. W. A. M. Mack, M.D. Dr. Charles Schlicthcr directs the 
X-ray work. A number of cases of carcinoma are improving under 
this treatment, with bright prospects of entire cure in time. A case 
of Hodgkin's disease, with marked involvement of the retro-peritoneal 
glands, has been much benefited by the treatment, the circumference 
of the abdomen having decreased several inches. The apparatus is 
used very frequently for diagnostic purposes. Any member of the 
County Society has the privilege of the use of the X-ray by paying a 
moderate fee. This money is used in the expense of running the 
machine, for new tubes, etc. 

No member of the society has died during the year ; six new mem- 
bers have been admitted, making a total of 69. 

P. Du Boise Bunting, Reporter. 



WARREN COUNTY. 

To the Chairman of the Standing Committee^ etc.: 

In answer to the questions propounded by the Chairman of the 
Standing Committee, would state as follows : 

1. To date I have received no "interesting" nor other "papers 
read before our society," which met June 3, 1903, in annual session, 
at Belvidere. 

2. Several interesting cases were brought before the society for 
discussion. 

3. The most prevalent diseases in our county have been diphtheria, 
typhoid fever, scarlet fever and smallpox — the town of Phillipsburg 
having more than its share. The Health Inspector of this town 



REPORTS OF DISTRICT SOCIETIES. 435 

reports thatp going back to October i. 1901, and ending October i, 
1902, there were 58 cases of diphtheria, 9 of scarlet fever, 9 of typhoid 
fever, and 2 cases of smallpox. He does not report the death rate 
during that time. From October i, 1902, to June 5. 1903, the 
Inspector informs me there were 30 cases of diphtheria with 4 deaths, 
7 cases of scarlet fever with no deaths, 60 cases of typhoid fever with 
6 deaths, and 16 cases of smallpox with no deaths. Smallpox is still 
lingering in Phillipsburg, but is well quarantined. 

4. I am happy to report that our society has lost none of its mem- 
bers by death during the past year. 

5. Our society holds its own in membership. I feel satisfied there 
are more outside than within the fold of the society, and, as a rule, 
these non-members contend that there is very little beneficial infor- 
mation to be obtained in or as members of the County Medical 
Society. *' Twas ever thus." 

Just here I will mention that the smallpox cases of Phillipsburg are 
under the care of a contract physician of Easton, Pa., at $10.00 per 
day, only one of the local physicians looking after his own smallpox 
cases. 

J. H. Griffith, M.D., Reporter, 



CONTENTS. 



PAGE. 

NOTICE OF NEXT ANNUAL MEETING i 

FELLOWS PRIZE ESSAY 3 

OFFICERS 6 

FELLOWS 7 

HONORARY MEMBERS 9 

PERMANENT DELEGATES ii 

MEMBERS OF DISTRICT SOCIETIES 15 

SUMMARY OF MEMBERS 39 

MINUTES 41 

APPENDIX TO THE MINUTES— 

Report of Treasurer 81 

Report of Recording Secretary 82 

Report of Corresponding Secretary 87 

Report of Committee on Business 89 

Report of Committee on Honorary Membership 90 

Report of Committee ON Abuse of Medical Charity 94 

Resolutions and Remarks on Licensing Opticians to 

Adapt Glasses, by Charles J. Kipp, M.D 96 

Report op Committee on Legislation 97 

Address of the President, by E. L. B. Godfrey. A.M., M.D.. 103 
The Organization and Operation op Hospitals and Other 
Charitable Institutions in the State of New Jersey, 

by Walter B. Johnson, M.D 121 

Report of Committee on Present Methods of Education 
FROM the Standpoint of the Physician, by Joseph Tom- 

linson, M.D 127 

Progress in Medicine and Therapeutics, by W. H. Ireland. 

M.D 133 

Progress in Laryngology, by B. A. Waddington, M.D 141 

Report on Progress of Surgery, by Charles Young, M.D 146 

Progress in Bacteriology, by R. B. Fitz-Randolph. A.C., 

F.R.M.S 161 

Progress in Ophthalmology, by Talbot R. Chambers, M.D... 170 
Gynecology ; Its History and Development, by Joseph M. 

Rector, M.D 173 

Report of a Case of Amoeba Coli Dysentery, by Philip 

Marvel, M.D 187 

Osteopathy, by Daniel Strock, M.D 196 



438 COxNTENTS. 



PAGE. 

Cantwell's Operation for Complete Epispadia, by F. V. 

Canlwall, M.D 206 

Infantile Colic, by Alexander McAIister, M.D 214 

The Alexander Operation in the Treatment of Retro- 
Displacement OF the Uterus, by F. M. Donahue, M.D.. . 220 

Retro-Displacements of the Uterus and Their Treat- 
ment, by J. M. Baldy, M.D 223 

Mosquitoes and Malaria, by J. J. Kinyoun, M.D., Ph.D...... 233 

Clinical Contributions to the Knowledge of Tubercular 
Disease op the Female Urinary Tract, by Edward J. 
Ill, M.D 256 

Two Unique Malformations of the Female Generative 
Organs— Absent Vagina with Atresia Uterus ; Uterus 
Dioelphis with Left Hematometra, by Emery Marvel. 
M.D Z70 

Some Practical Methods of Hydrotherapy for General 
Practice, by Eliot Gorton, M.D 279 

Two Cases op Transitory Complete Blindness of Both 

Eyes, by Charles J. Kipp, M.D 285 

Acute Inflammation of the Accessory Sinuses of the 

Nose, by Norton L. Wilson. M.D 290 

Surgical Interference in Abdominal Contusions, by Ed- 
ward A. Y. Schellenger, M.D 296 

Corneal Ulceration Due to Nasal Infection, by S. Lewis 

Zeigler, M.D 299 

Court Testimony of Medical Experts in Mental Dis- 
eases, by B. D. Evans, M.D 308 

Extensive FractureofSkull— Insertion Celluloid Plate 
—Traumatic Epilepsy and Relief by Subsequent Oper- 
ations, by John C. McCoy, M.D 318 

Excision of the Scapula, by Edwin Field, M.D 324 

Vaccination— How Long Does it Protect ? How Shall it 
BE Controlled? What are its Sanitary and Com- 
mercial Aspects ? By W. Updyke Selover, M.D 326 

Pneumonia and Pleurisy in Early Life Simulating Appen- 
dicitis, by J. P. Crozer Griffith, M.D 331 

Some Common Deformities and Their Prevention, by D. T. 

Bowden, M.D 343 

Constitution and By-Laws 349 

Report of Standing Committee 370 

IN MEMORIAM 376 

OBITUARIES— 

Theophilus Henry Boysen, M.D... 379 

Albertus Lyman Vandewater. M.D 379 



CONTENTS. 439 

PAGE. 

William L. Martin, M.D 380 

Jambs M. Ridgb, M.D 381 

Hon. Walter S. Leaming, M.D., D.D.S 382 

Isaac M. Downs, M.D 384 

Joseph Siieppard, M.D 384 

Arthur Ward, M.D 385 

Frederick Thum. M.D 386 

Henry Melville Smith, M.D 387 

Robert Morris Sutphen, M.D 387 

William McDanolds Struble, M.D 388 

Carlos Allen, M.D 389 

Sidney B. Strahley, M.D T 390 

REPORTS OF DISTRICT SOCIETIES- 
ATLANTIC COUNTY. Report by A. Burton Shimer. M.D 393 

BERGEN COUNTY, Report by J. W. Proctor. M.D 397 

BURLINGTOV COUNTY, Report by Joseph Stokes. M.D 40a 

CAMDEN COUNTY 403 

CAPE MAY COUNTY, Report by D. King Webster, M.D 412 

CUMBERLAND COUNTY, Report by H. P. Glendon. M.D 413 

ESSEX COUNTY. Report by William S. Disbrow, M.D 414 

GLOUCESTER OOUNTY. Report by W. Grant Simmons. M.D.. 416 

HUNTERDON COUNTY. Report by Leon T. Salmon, M.D. . . . 417 

MERCER COUNTY 419 

MIDDLESEX COUNTY, Report by H. L. Smith, M.D 422 

MORRIS COUNTY, Report by Stephen Pierson, M.D 423 

SALEM COUNTY. Report by W. H. Carpenter, M.D 423 

SOMERSET COUNTY, Report by W. H. Long, M.D 430 

SUSSEX COUNTY, Report by Shepard Voorhecs, M.D 432 

UNION COUNTY, Report by P. Du Boise Bunting, M. D 432 

WARREN COUNTY, Report by J. H. Griffith, M.D 434 



The Medical Society of New Jersey does not hold 
itself responsible for the sentiments expressed by the 
authors of papers; nor for the reports of clinical cases 
furnished by the reporters of the District Societies. — 
Transactions, 187^^ p^^g^ yS.